Robles-Medranda C, Nebel JA, Puga-Tejada M, Oleas R, Baquerizo-Burgos J, Ospina-Arboleda J, Valero M, Pitanga-Lukashok H. Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices. World J Gastrointest Endosc 2021; 13(1): 13-23 [PMID: 33520103 DOI: 10.4253/wjge.v13.i1.13]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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 Processing time: 95 Days and 16.9 Hours
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
