Published online Jan 16, 2021. doi: 10.4253/wjge.v13.i1.13
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
Bleeding gastric varices implies high morbidity and mortality in cirrhotic and noncirrhotic patients. Bleeding and rebleeding episodes, as well as their management, have a high health-related cost impact.
Currently, there is insufficient data about the cost-effectiveness of available therapies, mainly endoscopic cyanoacrylate injection and endoscopic ultrasound (EUS)-guided therapy for the management of gastric varices.
The study's main objective was to evaluate the cost-effectiveness of treating gastric varices, whether by the standard endoscopic cyanoacrylate injection or by the novel EUS-guided combined coiling and cyanoacrylate injection technique.
This was an observational, descriptive, and retrospective study conducted in a single tertiary center. Patients with actively bleeding gastric varices and those with a history of bleeding were treated with either one of the two modalities. We evaluated the technical success and adverse event rates and the procedure and overall treatment costs.
We described a significantly higher number of procedures needed to achieve obliteration of gastric varices in the endoscopic cyanoacrylate group, with a higher number of admissions in this cohort. Technical and adverse events rates were not significantly different in the two groups. In terms of cost, endoscopic cyanoacrylate injection has a significantly higher mean total treatment cost, probably explained by a higher reintervention rate and hospitalization cost.
In our study, EUS-guided combined therapy with coiling and cyanoacrylate injection proved to be more cost-effective than endoscopic cyanoacrylate injection in terms of the overall treatment cost.
We encourage researchers to conduct a multicenter, randomized trial with a long-term follow-up comparing the endoscopic cyanoacrylate therapy vs the EUS-guided combined therapy with coiling and cyanoacrylate injection, in order to define formal therapeutical guidelines.