Meta-analysis: Combination Endoscopic and Drug Therapy to Prevent Variceal Rebleeding in Cirrhosis

González, Ricardo García; Zamora, Javier; Gómez‐Camarero, Judith; Molinero, Luis-Miguel; Bañares, Rafael; Albillos, Agustı́n

doi:10.7326/0003-4819-149-2-200807150-00007

Cited by 167 publications

(86 citation statements)

References 36 publications

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“…The authors have demonstrated a significant impact on mortality with the use of terlipressin, when compared to placebo (79) . Even though the use of vasoactive drugs has been shown to be comparable to endoscopic treatment in the control of bleeding (45) , there are data showing that combined treatment with vasoactive drugs and endoscopic hemostasis is superior to each treatment modality in the control of bleeding and prevention of bleeding recurrence (7,9,72,94,155) . Of note, impact in reduction of mortality was observed in only one RCT that evaluated combination treatment of variceal bleeding with terlipressin and endoscopic therapy (94) .…”

Section: Recommendationsmentioning

confidence: 99%

“…Even in the absence of active bleeding, endoscopic treatment of esophageal varices is recommended after exclusion of other possible bleeding lesions, since a third of these patients with variceal hemorrhage have no signs of active bleeding at the moment of endoscopy (91) . Combined endoscopic and pharmacologic treatment is superior to each treatment modality (7,9,72,94,156) , but the use of vasoactive drugs should precede endoscopic hemostasis. Esophageal band ligation is the endoscopic treatment of choice (132) .…”

Section: ) Endoscopic Treatment Of Acute Variceal Bleedingmentioning

confidence: 99%

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Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

Bittencourt

Farias

Strauss

et al. 2010

Arq. Gastroenterol.

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-In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

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Section: Recommendationsmentioning

confidence: 99%

Section: ) Endoscopic Treatment Of Acute Variceal Bleedingmentioning

confidence: 99%

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

Bittencourt

Farias

Strauss

et al. 2010

Arq. Gastroenterol.

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“…The effect of carvedilol is similar to the propranolol or nadolol associated to prazosin and more potent (16%-43% vs pre-treatment values) compared to isolated propranolol or nadolol (12%-13% vs pretreatment values) (BANARES; MOITINHO et al, 2002). Carvedilol achieves a good hemodynamic response in more than 50% of patients non-responder to propranolol (REIBERGER; ULBRICH et al, 2013;GONZALEZ;ZAMORA et al, 2008;GARCIA-TSAO;.…”

Section: Artigos De Revisãomentioning

confidence: 98%

Cirrhotic Portal Hypertension: New Insights in an Old Syndrome

2015

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Liver Cirrhosis is currently understood as a pathological systemic process, inflammatory, vascular and, overall, dynamic and bidirectional. The intrahepatic circulation is the site of pronounced and determinant alterations characterized by the increase of mechanical resistance to the portal blood flow and the increase of the hepatic vascular tone. Compensated cirrhosis and decompensated cirrhosis can be described according to the presence and severity of portal hypertension. The most accurate method for diagnosis and stratification of portal hypertension is the measurement of the hepatic venous pressure gradient (HVPG). The standard pharmacological treatment available for cirrhotic portal hypertension consists, currently in the use of a non-selective beta-blocker(NSBB). A significant proportion of patients do not respond to treatment. Moreover, it seems to be a therapeutic window of the non-selective beta blockers in which very early stages of compensated cirrhosis and decompensated patients are not benefiting from that medication. The discovery of new drugs that might interfere in the disease's evolution and treat portal hypertension, allows a glimpse of a new horizon in hepatic cirrhosis. KEY WORDS:Cirrhotic Portal Hypertension; Pharmacological Therapy; Hepatic Venous Pressure Gradient.HIPERTENSÃO PORTA CIRRÓTICA: NOVAS PERSPECTIVAS SOBRE UMA SÍNDROME ANTIGA RESUMO: A cirrose Hepática é, atualmente, compreendida como um processo patológico sistêmico, inflamatório, vascular e, em geral, dinâmico e bidirecional. A circulação intra-hepática é o local de alterações pronunciadas e determinantes, caracterizadas pelo aumento da resistência mecânica ao fluxo sanguíneo portal e pelo aumento do tónus vascular hepático. A cirrose compensada e a descompensada podem ser descritas de acordo com a presença e gravidade da hipertensão porta. O método mais preciso para o diagnóstico e estratificação da hipertensão porta é a medida do gradiente de pressão venosa hepática (HVPG). O tratamento farmacológico disponível para a hipertensão porta cirrótica, nos dias atuais, consiste na utilização de um beta bloqueador não seletivo (NSBB). Uma proporção significativa dos pacientes não responde ao tratamento. Além disso, parece haver uma janela terapêutica dos beta-bloqueadores não seletivos, em que fases muito iniciais da cirrose compensada e pacientes descompensados não se beneficiam da medicação. Logo, a descoberta de novas drogas que possam interferir na evolução da doença e tratar a hipertensão porta, permite vislumbrar um novo horizonte na cirrose hepática.

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“…Conducted clinical trials comparing only non-selective beta blockers, non-selective beta blockers with mononitrates and endoscopic band ligation of varices demonstrated comparable efficacy in the prevention of recurrent bleeding and survival (17). The most recent meta-analysis suggests that combined therapy: pharmacotherapy and endoscopic therapy, is the most effective method (18).…”

Section: Prophylaxis Of Recurrent Bleeding Varicesmentioning

confidence: 99%

Practical Aproach to Variceal Gastrointestinal Bleeding – Association of Polish Surgeons Guidelines

Wallner¹,

Solecki²,

Ćwik³

et al. 2014

Polish Journal of Surgery

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Meta-analysis: Combination Endoscopic and Drug Therapy to Prevent Variceal Rebleeding in Cirrhosis

Abstract: A combination of endoscopic and drug therapy reduces overall and variceal rebleeding in cirrhosis more than either therapy alone.

Cited by 167 publications

References 36 publications

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

Cirrhotic Portal Hypertension: New Insights in an Old Syndrome

Practical Aproach to Variceal Gastrointestinal Bleeding – Association of Polish Surgeons Guidelines

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