Identification of High-Risk Individuals for Bleeding from Post-Endoscopic Variceal Band Ligation Ulceration

Rohita, Reji; Siobhan, Buckley Niamh; C, Justin; Hazeldine, Simon

doi:10.36959/621/604

Cited by 2 publications

(9 citation statements)

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“…The main study characteristics are provided in Table S5. The indication for EBL was elective (primary and/or secondary prophylaxis) in three studies, 12,21,23 urgent treatment of active variceal bleeding in one study, 22 and both elective prophylaxis and urgent treatment of acute variceal bleeding in 14 studies 4,5,7,8,11,13–20,22,24 . Sixteen included studies were unicentric and two were multicentric studies 12,14 .…”

Section: Resultsmentioning

confidence: 99%

“…Despite there was no signal pointing at any influence of reflux esophagitis on PBUB, a prophylactic treatment with PPI was administered in the majority of the included studies. The literature describe that PPI may diminish the size of PBUs, but in most studies PPI had no effect on bleeding complications or in mortality 5,18,25–28 . Only one study 29 reported a better outcome of EBL with long‐term PPIs administration.…”

Section: Discussionmentioning

confidence: 99%

“…The literature describe that PPI may diminish the size of PBUs, but in most studies PPI had no effect on bleeding complications or in mortality. 5,18,[25][26][27][28] Only one study 29 reported a better outcome of EBL with long-term PPIs administration. On the other hand, a judicious use of these drugs is needed due to their known adverse effects in patients with cirrhosis (pneumonia, hepatic encephalopathy, spontaneous bacterial peritonitis, osteoporosis).…”

Section: Discussionmentioning

confidence: 99%

“…The indication for EBL was elective (primary and/or secondary prophylaxis) in three studies, 12,21,23 urgent treatment of active variceal bleeding in one study, 22 and both elective prophylaxis and urgent treatment of acute variceal bleeding in 14 studies. 4,5,7,8,11,[13][14][15][16][17][18][19][20]22,24 Sixteen included studies were unicentric and two were multicentric studies. 12,14 Overall, these studies included a total of 9043 patients, 6819 (75.4%) male and 2224 (24.6%) female.…”

Section: Selection Process and Characteristics Of The Studiesmentioning

confidence: 99%

“…Studies were classified in high quality if ≥7 points, moderate quality if 5-6 points and low quality if ≤4 points. Thirteen studies were classified into high quality, 4,5,7,8,[11][12][13][14][15][16][17][18] four studies were at moderate risk of Bias. [19][20][21][22] Cochrane's ROB 2 Risk of Bias Tool was used to assess the risk of bias in two randomized controlled trials (Table S4).…”

Section: Key Pointsmentioning

confidence: 99%

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Predictors and management of post‐banding ulcer bleeding in cirrhosis: A systematic review and meta‐analysis

Nunes

Knecht

Wiest

et al. 2023

Liver International

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Background and Aims: Post-banding ulcer bleeding (PBUB) is an understudied complication of oesophageal varices endoscopic band ligation (EBL). This systematic review with meta-analysis aimed at: (a) evaluating the incidence of PBUB in patients with cirrhosis treated with EBL in primary or secondary prophylaxis or urgent treatment for acute variceal bleeding and (b) identifying predictors of PBUB. Methods:We conducted a systematic review of articles in English published in 2006-2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were made in eight databases including Embase, PubMed and Cochrane Library. Random-effects meta-analysis was used to determine the incidence, mean interval and predictors of PBUB.Results: Eighteen studies (9034 patients) were included. The incidence of PBUB was 5.5% (95% CI 4.3-7.1). The mean time for it to occur was 11 days (95% CI 9.94-11.97).Model for End-stage Liver Disease (MELD) score (OR 1.162, 95% CI 1.047-1.291) and EBL done in emergency setting (OR 4.902, 95% CI 2.99-8.05) independently predicted post-ligation ulcer bleeding. Treatment included drugs, endoscopic procedures and transjugular intrahepatic portosystemic shunt. Refractory bleeding was treated with self-expandable metallic stents or balloon tamponade. Mortality was on average 22.3% (95% CI 14.1-33.6). Conclusions:Patients with high MELD score and receiving EBL in an emergency setting are more prone to develop PBUB. Prognosis is still poor and the best therapeutic strategy to address remains to be ascertained.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Selection Process and Characteristics Of The Studiesmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

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Predictors and management of post‐banding ulcer bleeding in cirrhosis: A systematic review and meta‐analysis

Nunes

Knecht

Wiest

et al. 2023

Liver International

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The impact of restrictive blood transfusion on the safety of patients with esophageal varices after endoscopic variceal ligation

Chen,

Ming,

Chen

et al. 2023

Preprint

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Background: To study the effect of restrictive blood transfusion on the safety of early rebleeding after endoscopic variceal ligation(EVL) in patients with liver cirrhosis. Methods:The patients with cirrhosis and esophageal varices who underwent endoscopic variceal ligation at the Affiliated Hospital of North Sichuan Medical College from September 2021 to March 2023 were collected. The clinical data such as serum albumin level, hemoglobin level, liver function classification and the incidence of early rebleeding were recorded. The patients were divided into restrictive red blood cell transfusion group and non transfusion group according to whether there was red blood cell transfusion during hospitalization. The influence of restrictive transfusion and non transfusion group on the postoperative safety of endoscopic variceal ligation was observed. Results:A total of 246 cirrhotic patients were included in the analysis. There were significant differences in hemoglobin level, liver function classification, early rebleeding rate, hospitalization days, and hospitalization expenses between the restrictive transfusion and the non transfusion groups. The early rebleeding rate was significantly different between the groups with different hemoglobin levels after operation. Multivariate logistic analysis showed that postoperative hemoglobin level(OR=0.964, 95%CI: 0.956–0.971; P<0.001) and preoperative albumin level(OR=0.910, 95%CI: 0.892–0.929; P<0.001) were independent influencing factors of early rebleeding. Conclusions:The higher the hemoglobin level of cirrhotic patients with esophageal varices after endoscopic variceal ligation, the lower the incidence of early rebleeding, and restrictive blood transfusion appeared to increase the risk of early rebleeding, which needs be further confirmed in future research.

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Identification of High-Risk Individuals for Bleeding from Post-Endoscopic Variceal Band Ligation Ulceration

Cited by 2 publications

References 0 publications

Predictors and management of post‐banding ulcer bleeding in cirrhosis: A systematic review and meta‐analysis

Predictors and management of post‐banding ulcer bleeding in cirrhosis: A systematic review and meta‐analysis

The impact of restrictive blood transfusion on the safety of patients with esophageal varices after endoscopic variceal ligation

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