Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2021; 13(1): 13-23
Published online Jan 16, 2021. doi: 10.4253/wjge.v13.i1.13
Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices
Carlos Robles-Medranda, Joao Autran Nebel, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Jesenia Ospina-Arboleda, Manuel Valero, Hannah Pitanga-Lukashok
Carlos Robles-Medranda, Joao Autran Nebel, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Jesenia Ospina-Arboleda, Manuel Valero, Hannah Pitanga-Lukashok, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil 090505, Guayas, Ecuador
Author contributions: Robles-Medranda C and Pitanga-Lukashok H contributed to concept, design, definition of intellectual content, manuscript editing and manuscript review; Nebel JA, Oleas R, Valero M, and Ospina J contributed to data acquisition, literature search, manuscript preparation; Puga-Tejada M and Baquerizo-Burgos J contributed to statistical analysis, manuscript preparation, manuscript editing and manuscript review.
Institutional review board statement: This study was reviewed and approved by the Instituto Ecuatoriano de Enfermedades Digestivas Institutional Review Board.
Informed consent statement: Informed written consent was provided from all study participants or their legal guardians for attendance and research purposes.
Conflict-of-interest statement: Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, G-tech medical supply and MD consulting group. The other authors have nothing to disclose.
Data sharing statement: All available data can be requested by contacting the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos Robles-Medranda, MD, Chief Doctor, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel Romeo Castillo y Av. Juan Tanca Marengo, Torre Vitalis, Mezzanine 3, Guayaquil 090505, Guayas, Ecuador. carlosoakm@yahoo.es
Received: October 6, 2020
Peer-review started: October 6, 2020
First decision: December 1, 2020
Revised: December 9, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: January 16, 2021
Abstract
BACKGROUND

Cyanoacrylate (CYA) injection can be performed using a standard upper endoscopy technique or under endoscopic ultrasound (EUS) guidance alone or in combination with coils. There is little information available on the economic impact of these treatment methods.

AIM

To compare the cost-effectiveness of treating gastric varices by CYA injection via upper endoscopy vs coils plus CYA guided by EUS.

METHODS

This was an observational, descriptive, and retrospective study. Patients were allocated into two groups: A CYA group and coils plus CYA group. The baseline characteristics were compared, and a cost analysis was performed.

RESULTS

Overall, 36 patients were included (19 in the CYA group and 17 in the coils + CYA group). All patients in the CYA group had acute bleeding. They underwent a higher mean number of procedures (1.47 vs 1, P = 0.025), and the mean volume of glue used was 2.15 vs 1.65 mL, P = 0.133. The coils + CYA group showed a higher technical success rate (100% vs 84.2%), with a complication rate similar to the CYA group. The majority of CYA patients required hospitalization, and although the mean total per procedure cost was lower (United States $ 1350.29 vs United States $ 2978), the mean total treatment cost was significantly different (United States $ 11060.89 for CYA vs United States $ 3007.13 for coils + CYA, P = 0.03).

CONCLUSION

The use of EUS-guided coils plus cyanoacrylate is more cost-effective than cyanoacrylate injection when the total costs are evaluated. Larger, randomized trials are needed to validate the cost-effectiveness of the EUS-guided approach to treat gastric varices.

Keywords: Cost-effectiveness, Endoscopic ultrasound-guided therapy, Gastric varices, Gastrointestinal bleeding, Hemostasis, Therapy

Core Tip: There is little evidence regarding the economic impact of standard endoscopic cyanoacrylate therapy vs endoscopic ultrasound (EUS)-guided endovascular therapy in the management of gastric varices. In this retrospective study, we found that patients treated with endoscopic cyanoacrylate injection required hospitalization and had a significantly higher total treatment cost in comparison to those treated with an EUS-guided therapy. The incremental cost-effectiveness ratio analysis shows that in endoscopic therapy, each early rebleeding, adverse events, and day of hospitalization increased health-related costs on United States $ 2670.80, United States $ 8012.40, United States $ 127.18 per presented event, respectively, when comparing with coils + cyanoacrylate group cost and presented events. Each inevitable death on the endoscopic group represented a health-related cost increase on United States $ 8012.40 in comparison with EUS-guided therapy.