Band ligation versus no intervention for primary prevention of upper gastrointestinal bleeding in adults with cirrhosis and oesophageal varices

Vadera, Sonam; Yong, Charles; Gluud, Lise Lotte; Morgan, Marsha Y.

doi:10.1002/14651858.cd012673.pub2

Cited by 14 publications

(9 citation statements)

References 79 publications

(36 reference statements)

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“…Multiple randomized clinical trials have assessed the clinical efficacy of primary bleeding prophylaxis in patients with high-risk GEV. Both non-selective beta-blockers (NSBB) and endoscopic band ligation (EBL) are effective methods to reduce bleeding incidence (RR 0.6 and 0.4, respectively, when compared with no prophylaxis) [76,77]. Both primary prophylaxis strategies also improved all-cause mortality (RR 0.55-0.85 [76,77]) as most important clinical endpoint.…”

Section: Primary Prophylaxis Of Variceal Bleedingmentioning

confidence: 99%

“…Both non-selective beta-blockers (NSBB) and endoscopic band ligation (EBL) are effective methods to reduce bleeding incidence (RR 0.6 and 0.4, respectively, when compared with no prophylaxis) [76,77]. Both primary prophylaxis strategies also improved all-cause mortality (RR 0.55-0.85 [76,77]) as most important clinical endpoint. Direct comparison between both primary prophylaxis strategies does not show differences in all-cause mortality [78].…”

Section: Primary Prophylaxis Of Variceal Bleedingmentioning

confidence: 99%

See 1 more Smart Citation

Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?

Isfordink

Maan

Man

et al. 2021

European Journal of Internal Medicine

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Hepatocellular carcinoma (HCC) and variceal bleeding are among the most common causes of liver-related mortality in patients with hepatitis C virus (HCV)-induced cirrhosis. Current guidelines recommend HCC and gastroesophageal varices (GEV) surveillance in patients with HCV infection and cirrhosis. However, since the recent introduction of direct-acting antivirals, most patients with cirrhosis are now cured of their chronic HCV infection. As virological cure is considered to substantially reduce the risk of cirrhosis-related complications, this review discusses the current literature concerning the surveillance of HCC and GEV in patients with HCV-induced cirrhosis with a focus on the setting following sustained virological response.

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Section: Primary Prophylaxis Of Variceal Bleedingmentioning

confidence: 99%

Section: Primary Prophylaxis Of Variceal Bleedingmentioning

confidence: 99%

Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?

Isfordink

Maan

Man

et al. 2021

European Journal of Internal Medicine

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“…As has been proven earlier such strategy is associated with reduced mortality. 12 Only minor periprocedural complications during VBL were reported in the literature, e.g., temporary cardiac arrhythmias, focal pain, or vasovagal response, with frequency less than 1%. It is also worth stressing that HVPG measurements can proceed in less than 15 minutes with a trans-jugular approach with simultaneous liver biopsy.…”

Section: Discussionmentioning

confidence: 97%

Invasive measurement of portal hypertension in the hemodynamics laboratory as an important element of qualification for the treatment of esophageal varices: A single-center experience

et al. 2021

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Introduction: The measurement of hepatic venous pressure gradient (HVPG) is an essential prognostic factor in subjects with chronic liver disorders. Aim: The present study aimed to present the feasibility and applicability of HVPG in the modern hemodynamics laboratory in patients with liver cirrhosis as a stage for qualification in variceal band ligation (VBL). Material and methods: We included 78 patients with liver cirrhosis and esophageal varices, who had HVPG measurements taken at the hemodynamics laboratory between January 2015 and January 2019. Results and discussion: The mean age was 55.5 ± 10.9 years, and 66.7% were males. The most common cause of liver cirrhosis was alcohol abuse (65.4%), and the most common varices stage was 3 (83.3%). The mean HVPG was 16.3 ± 6.2 mm Hg. In total, 67 (85.9%) patients had HVPG over 10 mm Hg and underwent VBL. No periprocedural complications were observed. At 12 months, recurrent hospitalizations were observed in 67 (85.9%), 5 (6.4%)had cirrhosis-related bleeding episodes, and 4 (5.1%) patients died. Conclusions: HVPG measurement is a feasible, safe and reproducible procedure that provides valuable diagnostic/prognostic information and helps make therapeutic decisions. This procedure can be done quickly in the modern hemodynamics laboratory.

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“…Patients with liver cirrhosis are at risk of GI bleeding; the risk in patients with liver fibrosis is yet unknown [ 14 ]. The main reason is portal hypertension with a portal venous pressure over 10 mmHg leading to esophageal and gastric varices and portal hypertensive gastropathy [ 15 , 29 ]. Remarkably, in our SC-CIP cohort, cirrhosis and signs of portal hypertension (splenomegaly, thrombopenia) were present in under 30% of patients at time of bleeding.…”

Section: Discussionmentioning

confidence: 99%

High Rate of Gastrointestinal Bleeding in Patients with Secondary Sclerosing Cholangitis in Critically Ill Patients (SC-CIP)

Blesl

Eibisberger

Schörghuber

et al. 2021

JCM

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Secondary sclerosing cholangitis in critically ill patients (SC-CIP) is a rare cholestatic liver disease triggered by long-term intensive care treatment. The aim of this study was to evaluate the frequency and characteristics of gastrointestinal bleeding in SC-CIP. Patients with diagnosed SC-CIP were retrospectively identified and compared to a control group of patients with cardiac surgery and intensive care treatment but without the development of SC-CIP. Fifty-three patients with SC-CIP and 19 controls were included in the study. The frequency of gastrointestinal bleeding was 30% in SC-CIP (16 patients) and 5% in the control group (1 patient) (p = 0.03). Bleeding occured in the mean 13 months after admission to an intensive care unit in SC-CIP, three patients (19%) suffered bleeding during intensive care treatment. Three SC-CIP patients (19%) had cirrhosis at the time of bleeding, five (31%) had splenomegaly, and four (25%) received oral anticoagulation. In SC-CIP, 13 bleedings were identified in the upper gastrointestinal tract, two in the lower, and one remained unknown. The most common reasons for bleeding were gastroduodenal ulcers. In total, 80% of patients needed blood units, and one death due to bleeding occurred in SC-CIP. In conclusion, gastrointestinal bleeding is a frequent complication in patients with SC-CIP. Whether the liver disease itself or cofactors cause the susceptibility for bleeding remains unclear.

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Band ligation versus no intervention for primary prevention of upper gastrointestinal bleeding in adults with cirrhosis and oesophageal varices

Abstract: Band ligation versus no intervention for primary prevention of upper gastrointestinal bleeding in adults with cirrhosis and oesophageal varices.

Cited by 14 publications

References 79 publications

Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?

Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?

Invasive measurement of portal hypertension in the hemodynamics laboratory as an important element of qualification for the treatment of esophageal varices: A single-center experience

High Rate of Gastrointestinal Bleeding in Patients with Secondary Sclerosing Cholangitis in Critically Ill Patients (SC-CIP)

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