Endoscopic Thrombin Injection for Gastric Variceal Bleeding: A Systematic Review and Meta‐Analysis of Observational and Trial Data

Objective The safety of endoscopic thrombin injection (ETI) for treating the bleeding of gastric varix (GV) in patients with portal hypertension requires further evaluation. This meta‐analysis systematically reviews the available evidence on the efficacy and safety of ETI for GV bleeding. Methods Two researchers independently screened and extracted data from all relevant original articles published from database inception to May 2025. Study quality was assessed using the Methodological Index for Non‐Randomized Studies tool. Meta‐analysis was performed using RevMan 5.3 software, with risk of bias assessed via risk of bias plots and funnel plots. Results Thirteen studies involving 417 patients were included. Meta‐analysis revealed an initial hemostasis rate of 93% (95% confidence interval [ CI ]: 0.89–0.95), a 5‐day rebleeding rate of 11% (95% CI : 0.07–0.17), a late rebleeding rate of 14% (95% CI : 0.11–0.19), a complete GV obliteration rate of 36% (95% CI : 0.11–0.73), and a 6‐week GV‐related mortality rate of 9% (95% CI : 0.06–0.15). The overall complication rate was 2.2% (9/417), with fever and leukocytosis being the most common events. Conclusion Endoscopic thrombin injection for GV bleeding appears to achieve high initial hemostasis with low rates of rebleeding in the available studies. Reported complication rates were low, though systematic assessment was not consistently described across studies. It is suggested the potential efficacy and an acceptable safety profile within the available evidences.