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. 2021 Jan 16;13(1):13-23.
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  1 , Joao Autran Nebel  2 , Miguel Puga-Tejada  2 , Roberto Oleas  2 , Jorge Baquerizo-Burgos  2 , Jesenia Ospina-Arboleda  2 , Manuel Valero  2 , Hannah Pitanga-Lukashok  2
Affiliations

Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

Carlos Robles-Medranda et al. World J Gastrointest Endosc. .

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.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Study flowchart. CYA: Cyanoacrylate; GOV: Gastroesophageal varices; IGV: Isolated gastric varices; USD: United States dollar.
Figure 2
Figure 2
Endoscopic view of actively bleeding type II gastroesophageal varices treated with endoscopic cyanoacrylate injection.
Figure 3
Figure 3
Endoscopic ultrasound-guided coiling plus cyanoacrylate injection for the management of gastric varices. A: Endoscopic ultrasound (EUS)-Doppler evaluation of the gastric varix feeder vessel; B: EUS-guided fine-needle puncture and cyanoacrylate injection; C: Fluoroscopic view of EUS-guided coiling of gastric varices; D: EUS-Doppler demonstrating absence of flow after combined therapy.
Figure 4
Figure 4
The Incremental Cost-Effective ratio equation.
See this image and copyright information in PMC

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