Favorable Effects of Endoscopic Ligation Combined with Drugs on Rebleeding and Mortality in Cirrhotic Patients: A Network Meta-Analysis

2017 ◽  
Vol 36 (2) ◽  
pp. 136-149 ◽  
Author(s):  
Liang Shi ◽  
Xueping Zhang ◽  
Jianye Li ◽  
Xibo Bai
Keyword(s):  
Beta Blockers ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Isosorbide Mononitrate ◽  
Endoscopic Variceal Ligation ◽  
Variceal Hemorrhage ◽  
Combination Therapies ◽  
Previous Episode ◽  
Cirrhotic Patients ◽  
Endoscopic Ligation

Background: To assess the effects of combination therapies (endoscopic plus drug[s], drug combinations) on variceal/any-cause rebleeding and mortality among cirrhotic patients with one previous episode of variceal hemorrhage. Summary: We searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. We included 26 randomized controlled trials involving 2,536 adults using OR to measure the effects. Endoscopic variceal ligation (EVL) plus nadolol ranked first for reducing recurrent bleeds. Both EVL + nadolol and EVL + drugs (nadolol, sucralfate) decreased the risk of any-cause rebleeding than EVL alone (OR 0.34, 95% CI 0.12–0.97; OR 0.40, 95% CI 0.18–0.88, respectively). Meanwhile, EVL + drugs ranked first lowering mortality rates (P-score >0.85) with a marginal superiority over EVL alone (OR 0.52, 95% CI 0.26–1.01). Beta-blockers with isosorbide mononitrate (ISMN) also reached a marginal superiority (OR 0.78, 95% CI 0.56–1.09) for improving mortality. Key Messages: Our findings indicated that EVL + nadolol might be the preferred choice to cirrhotic patients with one previous episode of variceal hemorrhage for preventing rebleeding. EVL + nadolol + sucralfate and beta-blockers + ISMN may be potential alternatives to improve mortality. Further, well-controlled studies are warranted to compare the promising combination therapies.

scholarly journals Endoscopic Band Ligation Versus Pharmacological Therapy for Variceal Bleeding in Cirrhosis: A Meta-Analysis

2011 ◽  
Vol 25 (3) ◽  
pp. 147-155 ◽  
Author(s):  
Lan Li ◽  
Chaohui Yu ◽  
Youming Li
Keyword(s):  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Pharmacological Therapy ◽  
Cochrane Library ◽  
Isosorbide Mononitrate ◽  
Variceal Hemorrhage ◽  
Band Ligation ◽  
Endoscopic Band Ligation

OBJECTIVE: To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the efficacy of endoscopic band ligation (EBL) versus pharmacological therapy for the primary and secondary prophylaxis of variceal hemorrhage in patients with cirrhosis.METHODS: Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases. Eighteen randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis.RESULTS: Among 1023 patients in 12 trials comparing EBL with beta-blockers for primary prevention, there was no significant difference in gastrointestinal bleeding (RR 0.79 [95% CI 0.61 to 1.02]), all-cause deaths (RR 1.06 [95% CI 0.86 to 1.30]) or bleeding-related deaths (RR 0.66 [95% CI 0.38 to 1.16]). There was a reduced trend toward significance in variceal bleeding with EBL compared with beta-blockers (RR 0.72 [95% CI 0.54 to 0.96]). However, variceal bleeding was not significantly different between the two groups in high-quality trials (RR 0.84 [95% CI 0.60 to 1.17]). Among 687 patients from six trials comparing EBL with beta-blockers plus isosorbide mononitrate for secondary prevention, there was no effect on either gastrointestinal bleeding (RR 0.95 [95% CI 0.65 to 1.40]) or variceal bleeding (RR 0.89 [95% CI 0.53 to 1.49]). The risk for all-cause deaths in the EBL group was significantly higher than in the medical group (RR 1.25 [95% CI 1.01 to 1.55]); however, the rate of bleeding-related deaths was unaffected (RR 1.16 [95% CI 0.68 to 1.97]).CONCLUSIONS: Both EBL and beta-blockers may be considered first-line treatments to prevent first variceal bleeding, whereas beta-blockers plus isosorbide mononitrate may be the best choice for the prevention of rebleeding.

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 Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 48 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Jingjing Jin ◽  
Xiaoyang Guo ◽  
Qiyao Yu
Keyword(s):  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Dialysis Patients ◽  
Statistical Heterogeneity ◽  
All Cause Mortality ◽  
Β Blockers

Background: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, β-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of β-blockers therapy in adult patients treated with dialysis. Methods: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of β-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. Results: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between β-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54–0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29–0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31–0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48–0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80–0.92) between β-blockers and no β-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57–1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50–1.26). Conclusions: β-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club “Cappuccino with Claudio Ronco” at  https://www.karger.com/Journal/ArticleNews/496083?sponsor=52

scholarly journals The Best Anticoagulation Strategy for Cirrhotic Patients who Underwent Splenectomy: A Network Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Cheng Gong ◽  
Xian Qin ◽  
Jian Yang ◽  
Tao Guo
Keyword(s):  
Antithrombin Iii ◽  
Meta Analysis ◽  
Therapeutic Strategies ◽  
Cochrane Library ◽  
Cumulative Probability ◽  
Review Of The Literature ◽  
Good Convergence ◽  
First Choice ◽  
Cirrhotic Patients ◽  
The Cochrane Library

Objective. To determine the best anticoagulation strategy for the patients who underwent splenectomy with cirrhosis through network meta-analysis. Methods. We conducted a systematic review of the literature in PubMed, Embase, and the Cochrane Library database. We extracted data on incidence of Portal vein system thrombosis (PVST) from studies that compared various anticoagulation strategies for use with patients who underwent splenectomy with cirrhosis. Network meta-analysis was conducted in ADDIS by evaluating the different incidence of PVST. Consistency and inconsistency models were developed to identify differences among the therapeutic strategies. Cumulative probability was utilized to rank the strategies under examination. Results. A total of 11 studies containing 1153 patients were included in the network meta-analysis. The results revealed that the application of Antithrombin III was the best anticoagulation option for patients who underwent splenectomy with cirrhosis (P=0.59). The data of consistency and inconsistency models exhibited basically consistent and showed good convergence. Conclusions. Application of Antithrombin III seemed to be the best anticoagulation strategy for cirrhotic patients who underwent splenectomy and should be considered a first-choice clinical reference.

scholarly journals Necessity of vasoconstrictors for esophageal variceal bleeding after endoscopic ligation: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Jen-Hao Yeh ◽  
Gin Lo ◽  
Ru-Yi Huang ◽  
Chih-Wen Lin ◽  
Wen-Lun Wang
Keyword(s):  
Treatment Failure ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Current Evidence ◽  
Cochrane Library ◽  
Combination Regimen ◽  
Endoscopic Variceal Ligation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Abstract BackgroundSeveral recent trials have suggested that the need for vasoconstrictors for preventing esophageal variceal bleeding may be considerably reduced after endoscopic variceal ligation (EVL). However, comprehensive systematic reviews on this topic are hardly available. MethodsA meticulous literature review and meta-analysis were conducted using the databases of PubMed, Embase, and the Cochrane Library. Primary outcomes were initial hemostasis, rebleeding, mortality, and treatment failure within 5 days, and secondary outcomes were 6-week mortality and adverse events. ResultsFive randomized trials with 423 participants were included in the meta-analysis. The results revealed that the following outcomes were similar in groups that received only EVL and a standard combination regimen: initial hemostasis (97.6% vs. 98.0%, risk ratio (RR) = 1.00, 95% confidence interval (CI) = 0.97–1.02), 5-day rebleeding (15.9% vs. 6.6%, RR = 2.25, 95% CI = 0.87–5.77), treatment failure (9.6% vs. 6.7%, RR = 1.43, 95% CI = 0.54––3.75), 5-day mortality rates (0 vs. 0.7%, RR = 0.81, 95% CI = 0.09–6.87), and 6-week mortality rates (2.9% vs. 3.0%, RR = 0.88, 95% CI = 0.25–3.13). By contrast, sensitivity analysis suggested obvious clinical heterogeneity in 5-day rebleeding although an outlier study was identified. ConclusionIn patients with acute esophageal variceal bleeding after EVL, 5-day and 6-week mortality rates were similar regardless of vasoconstrictor use. However, considering the controversial 5-day rebleeding rate, short course of vasoconstrictor use based on current evidence may be reasonable.

Sign in / Sign up

Export Citation Format

Share Document