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    Interventional procedure overview of transvenous obliteration for gastric varices

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    Validity and generalisability of the studies

    • The patient populations of included studies were generally comparable in terms of age, sex, location and form of gastric varices, and severity of liver disease.

    • Transvenous obliteration was used for primary or secondary prophylaxis, or in actively bleeding gastric varices.

    • Four types of transvenous obliteration were considered (BRTO, BATO, CARTO, and PARTO). However, there is very limited comparative evidence.

    • There are technical differences in how each procedure is performed. For example, the sclerosant used. Different sclerosing agents may have different risk/benefit profiles.

    • In the Park (2015) systematic review and meta-analysis (BRTO outcomes), all studies except 1 were retrospective. In the Paleti (2020) systematic review and meta-analysis (BRTO vs. TIPS), all studies except 1 were non-randomised. One RCT was included in the Osman (2022) network meta-analysis – Luo (2021; BRTO vs. endoscopic cyanoacrylate injection) – and Luo (2021) was also included in the key evidence section of this overview (Study 4). All other studies were retrospective, non-randomised case series or cohort studies.

    • There may be limited generalisability to a UK clinical practice context. This is due to:

      • Studies were conducted primarily in Korea, China, and Japan.

      • Non-selective β-blockers were not used in almost all the studies. These agents are commonly used in people with previous variceal bleeding in the UK.

      • In most studies, the predominant aetiology of liver disease was viral hepatitis. This differs from the UK, where alcohol-related liver disease is most prominent.

    • The longest follow up was 191 months (upper bound of Naeshiro, 2014), with the longest median follow up of 60 months (Naeshiro, 2014).