Cyanoacrylate Injection Compared with Band Ligation for Acute Gastric Variceal Hemorrhage: A Meta-Analysis of Randomized Controlled Trials and Observational Studies

Background. Cyanoacrylate injection (GVO) and band ligation (GVL) are effective treatments for gastric variceal hemorrhage. However, data on the optimal treatment are still controversial. Methods. For our overall analysis, relevant studies were identified from several databases. For each outcome, data were pooled using a fixed-effect or random-effects model according to the result of a heterogeneity test. Results. Seven studies were included. Compared with GVL, GVO was associated with increased likelihood of hemostasis of active bleeding (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.19-4.51) and a longer gastric variceal rebleeding-free period (hazard ratio = 0.37; 95% CI = 0.24-0.56). No significant differences were observed between GVL and GVO for mortality (hazard ratio = 0.66; 95% CI = 0.43-1.02), likelihood of variceal obliteration (OR = 0.89; 95% CI = 0.52-1.54), number of treatment sessions required for complete variceal eradication (weighted mean difference = -0.45; 95% CI = -1.14-0.23), or complications (OR = 1.02; 95% CI = 0.48-2.19). Conclusion. GVO may be superior to GVL for achieving hemostasis and preventing recurrence of gastric variceal rebleeding but has no advantage over GVL for mortality and complications. Additional studies are warranted to enable definitive conclusions.