Balloon Tamponade and Esophageal Stenting for Esophageal Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 39 (02) ◽  
pp. 178-194 ◽  
Author(s):  
Susana Rodrigues ◽  
Andrés Cárdenas ◽  
Àngels Escorsell ◽  
Jaime Bosch
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Balloon Tamponade ◽  
Acute Variceal Bleeding

AbstractFailure to control variceal bleeding with current recommendations occurs in 10 to 20% of cases. This systematic review and meta-analysis analyzes the experience, results, and complications of “bridge” therapies for failure to control acute variceal bleeding: balloon tamponade and esophageal stents. The main outcomes assessed were failure to control bleeding and mortality in the short-term and medium-term follow-up, and adverse events. Balloon tamponade studies had a pooled rate of short-term failure to control bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death. Stenting failed to control bleeding in the short term and medium term in 12.7 and 21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies. Although only one trial compared these treatments, the available evidence consistently supports that stents serve as a better and safer bridge therapy in refractory acute variceal bleeding.

scholarly journals Short-course vasoconstrictors are adequate for esophageal variceal bleeding after endoscopic variceal ligation: A systematic review and meta-analysis

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110317
Author(s):  
Jen-Hao Yeh ◽  
Gin-Ho Lo ◽  
Ru-Yi Huang ◽  
Chih-Wen Lin ◽  
Wen-Lun Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Endoscopic Variceal Ligation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Short Course ◽  
Significant Difference

Endoscopic variceal ligation (EVL) with vasoconstrictors has been recommended for acute esophageal variceal bleeding. However, the optimal duration of vasoconstrictors after EVL is controversial. This systematic review and meta-analysis was conducted to explore the efficacy of short-course vasoconstrictors (≤3 days) versus standard combination (3–5 days). A comprehensive literature review was conducted using the PubMed, Embase, and Cochrane library databases with subsequent meta-analysis. The primary outcomes were 5-day rebleeding, mortality, and treatment failure rates. A risk ratio (RR) with 95% confidence interval is used for outcome comparison. Nine randomized studies with 838 patients were included. The initial hemostasis (96.8% vs 97.4%, p = 0.919), 5-day rebleeding (11.2% vs 8.3%, RR = 1.05, 95% CI = 0.62–1.76), mortality (0 vs 1.3%, RR = 0.48, 95% CI = 0.10–2.39), and treatment failure (7.4% vs 5.9%, RR = 1.10, 95% CI = 0.48–2.49) were similar in both groups. Subgroup analysis suggested EVL alone had no significant difference of 5-day re-bleeding (15.9% vs 7.1%, RR = 2.25, 95% CI = 0.87–5.77), mortality (0 vs 0.7%, RR = 0.71, 95% CI = 0.08–6.03), treatment failure (9.6% vs 6.7%, RR = 1.43, 95% CI = 0.54–3.75) compared to standard combination. Clinical heterogeneity was found for the rebleeding rate for the subgroup during sensitivity analysis. EVL with short-course vasoconstrictors is highly efficacious for esophageal variceal bleeding. Further studies are required to determine the genuine need of subsequent vasoconstrictor after successful EVL.

scholarly journals Mo1531 – Early (Pre-Emptive) Tips Versus Conventional Treatment for Prophylaxis of Esophageal Variceal Bleeding: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 156 (6) ◽  
pp. S-1333-S-1334
Author(s):  
Shadi Hamdeh ◽  
Osama Altayar ◽  
Muhammad Aziz ◽  
Jihan Fathallah ◽  
Mojtaba S. Olyaee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Variceal Bleeding ◽  
Conventional Treatment ◽  
Meta Analysis ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

scholarly journals Efficacy of endoscopic treatments for acute esophageal variceal bleeding in cirrhotic patients: systematic review and meta-analysis

2019 ◽  
Vol 07 (11) ◽  
pp. E1503-E1514 ◽  
Author(s):  
Fernanda de Quadros Onofrio ◽  
Julio Carlos Pereira-Lima ◽  
Felipe Marquezi Valença ◽  
André Luis Ferreira Azeredo-da-Silva ◽  
Airton Tetelbom Stein
Keyword(s):  
Systematic Review ◽  
Variceal Bleeding ◽  
Control Measure ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Esophageal Resection ◽  
Bleeding Control ◽  
Vasoactive Drugs ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Abstract Background and aim Guidelines recommend use of ligation and vasoactive drugs as first-line therapy and as grade A evidence for acute variceal bleeding (AVB), although Western studies about this issue are lacking. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of endoscopic treatments for AVB in patients with cirrhosis. Trials that included patients with hepatocellular carcinoma, use of portocaval shunts or esophageal resection, balloon tamponade as first bleeding control measure, or that received placebo or elective treatment in one study arm were excluded. Results A total of 8382 publications were searched, of which 36 RCTs with 3593 patients were included. Ligation was associated with a significant improvement in bleeding control (relative risk [RR] 1.08; 95 % confidence interval [CI] 1.02 – 1.15) when compared to sclerotherapy. Sclerotherapy combined with vasoactive drugs showed higher efficacy in active bleeding control compared to sclerotherapy alone (RR 1.17; 95 % CI 1.10 – 1.25). The combination of ligation and vasoactive drugs was not superior to ligation alone in terms of overall rebleeding (RR 2.21; 95 %CI 0.55 – 8.92) and in-hospital mortality (RR 1.97; 95 %CI 0.78 – 4.97). Other treatments did not generate meta-analysis. Conclusions This study showed that ligation is superior to sclerotherapy, although with moderate heterogeneity. The combination of sclerotherapy and vasoactive drugs was more effective than sclerotherapy alone. Although current guidelines recommend combined use of ligation with vasoactive drugs in treatment of esophageal variceal bleeding, this study failed to demonstrate the superiority of this combined treatment.

Comparison of Therapies for Primary Prevention of Esophageal Variceal Bleeding: A Systematic Review and Network Meta‐analysis

Hepatology ◽  
2019 ◽  
Vol 69 (4) ◽  
pp. 1657-1675 ◽  
Author(s):  
Mayank Sharma ◽  
Siddharth Singh ◽  
Vivek Desai ◽  
Vijay H. Shah ◽  
Patrick S. Kamath ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Prevention ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

EP.WE.14Prognostic significance of metabolic syndrome in patients undergoing carotid artery revascularisation: A systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Adverse Events ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Long Term Outcomes ◽  
Short Term ◽  
All Cause Mortality ◽  
Major Adverse Events

Abstract Aims to evaluate prognostic significance of metabolic syndrome (MetS) in patients undergoing carotid artery revascularisation. Methods A systematic review and meta-analysis was performed in compliance with PRISMA standards to evaluate prognostic significance of MetS in patients undergoing carotid endarterectomy or carotid stenting. Short-term (<30 days) postoperative outcomes (all-cause mortality, stroke or transient ischaemic attack (TIA), myocardial infarction, major adverse events) and long-term outcomes (restenosis, all-cause mortality, stroke or TIA, myocardial infarction, major adverse events) were considered as outcomes of interest. Random effects modelling was applied for the analyses. Results Analysis of 3721 patients from five cohort studies showed no difference between the MetS and no MetS groups in terms of the following short-term outcomes: all-cause mortality (OR: 1.67,P=0.32), stroke or TIA (OR: 2.44,P=0.06), myocardial infarction (OR: 1.01,P=0.96), major adverse events (OR: 1.23, P = 0.66). In terms of long-term outcomes, MetS was associated with higher risk of restenosis (OR: 1.75,P=0.02), myocardial infarction (OR: 2.12,P=0.04), and major adverse events (OR: 1.30, P = 0.009) but there was no difference between the two groups in terms of all-cause mortality (OR: 1.11, P = 0.25), and stroke or TIA (OR: 1.24, P = 0.33). The quality and certainty of the available evidence were judged to be moderate. Conclusions The best available evidence suggest that although MetS may not affect the short-term postoperative morbidity and mortality outcomes in patients undergoing carotid revascularisation, it may result in higher risks of restenosis, myocardial infarction and major adverse events in the long-term. Evidence from large prospective cohort studies are required for more robust conclusions.

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