Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis

Torres, Maria Corina Plaz; Best, Lawrence; Freeman, Suzanne C.; Roberts, Danielle; Cooper, Nicola J.; Sutton, Alex J.; Roccarina, Davide; Benmassaoud, Amine; Prat, Laura Iogna; Williams, Norman; Csenar, Mario; Fritche, Dominic; Begum, Tanjia; Arunan, Sivapatham; Tapp, Maxine; Milne, EJ; Pavlov, Chavdar S; Davidson, Brian R; Tsochatzis, Emmanuel; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd013122.pub2

Cited by 15 publications

(9 citation statements)

References 345 publications

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“…It has been shown that approximately 30–40% of liver cirrhosis patients exhibit upper gastrointestinal bleeding as the disease progresses, which is often the most common cause of first hospitalization in patients with advanced cirrhosis [ 22 ]. Also, several studies have reported that EGVB can complicate the outcome in liver cirrhosis patients [ 23 – 25 ]. These studies have further analyzed the risk factors of bleeding and rebleeding after endoscopic treatment to inhibit the recurrence of EGVB and improve the quality of life of these patients.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Complications and Risk Factors Other than Bleeding before and after Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis

Duan

He²,

Yan³

et al. 2023

Canadian Journal of Gastroenterology and Hepatology

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Objective. To identify any concomitant complications other than bleeding (COTB) before and after endoscopic treatment of esophagogastric variceal bleeding (EGVB) in liver cirrhosis patients and explore the underlying risk factors. Materials and Methods. Cirrhotic patients complicated with EGVB, who underwent interventional endoscopic treatments in our hospital from November 2017 to August 2020, were enrolled in this study. Clinical data were retrospectively analyzed for COTB at admission and within 2 years of the first endoscopic treatment. Patients were screened for potential risk factors of COTB before and after the treatment. Univariate analysis was performed to identify clinical factors of secondary complications, and statistically significant factors were included in the multivariate Cox and logistic regression analyses. Results. Of the 547 patients with cirrhosis, 361 individuals had COTB in the first endoscopic treatment. In this cohort, the top 3 prevalent incidences were portal vein thrombosis (PVT) or spongiosis, cholelithiasis, and pathogenic infections. The COTB did not occur at admission in 171 liver cirrhosis patients but happened at the follow-up. Higher Child-Pugh scores indicated potential risks of multiple concurrent complications, including bleeding. Risk factors for concomitant PVT or cavernous changes after endoscopic treatment of EGVB, pathogenic infections, and cholelithiasis could prolong the cirrhosis symptoms, while noncholestatic cirrhosis patients might have a lower risk than posthepatitis B cirrhosis patients, in the context of a higher degree of EGV and serum level of D-D and a lower blood calcium level. Conclusions. Clinical treatment and interventions can be tailored to avoid other complications during and after EGVB treatment, which can affect the outcome and prognosis of bleeding symptoms.

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Section: Discussionmentioning

confidence: 99%

Analysis of Complications and Risk Factors Other than Bleeding before and after Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis

Duan

He²,

Yan³

et al. 2023

Canadian Journal of Gastroenterology and Hepatology

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“…There was no difference in mortality between ligation alone and ligation plus NSBBs for prevention of rebleeding. It is difficult to deduce from a recent network meta-analysis (3,526 participants, 48 randomized trials) the effect of NSBBs on survival when compared to other active treatments ( 131 ). It does not appear that there is a major difference.…”

Section: Indications For Nsbbs Results From Randomized Trialsmentioning

confidence: 99%

Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

et al. 2023

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With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, the beneficial effect of carvedilol, which blocks alpha and beta receptors, has been highlighted. Carvedilol leads to “biased-signaling” via recruitment of beta-arrestin. This effect and its consequences have not been sufficiently investigated in patients with liver cirrhosis. Also, a number of questions remain open regarding the expression of beta-receptors and its intracellular signaling and the respective consequences in the intra- and extrahepatic tissue compartments. Despite the undisputed role of non-selective beta-blockers in the treatment of liver cirrhosis, we still can improve the knowledge as to when and how beta-blockers should be used in which patients.

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“…Also, the volume of rebleeding reduced and the therapeutic effect was better ( 13 ). The risk of rebleeding after endoscopy is mainly related to the level of portal hypertension, the severity of varices, and the status of coagulation function in patients ( 32 ). Based on these results, we recommend endoscopic primary prophylaxis for patients with cirrhosis complicated with esophagogastric varices, rather than waiting for emergency treatment after the first episode of variceal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Endoscopic Primary Prophylaxis and Rebleeding in Liver Cirrhosis Patients with Esophagogastric Variceal Bleeding

et al. 2022

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AimTo identify the association between endoscopic primary prophylaxis and the risk of rebleeding in patients with liver cirrhosis receiving endoscopic therapy.MethodsThis cohort study involved in 944 liver cirrhosis patients with esophagogastric variceal bleeding (EGVB) receiving endoscopic therapy. All participants were divided into two groups: rebleeding group (n = 425) and non-rebleeding group (n = 519) according to the occurrence of rebleeding in patients. Rebleeding indicated any bleeding after endoscopic therapy for the first bleeding of esophagogastric varices in liver cirrhosis patients. Univariate and multivariate logistic analyses were employed to identify the association between endoscopic primary prophylaxis and rebleeding in patients with liver cirrhosis after endoscopic therapy.ResultsIn total, 425 patients rebleeded at the end of the follow-up. The risk of rebleeding in patients with endoscopic primary prophylaxis decreased by 0.773 times (OR = 0.227, 95%CI: 0.139–0.372, P < 0.001) after adjusting covariables. Subgroups were divided according to the Child-Pugh (CP) score, and the results revealed that the risk of rebleeding in patients with endoscopic primary prophylaxis decreased by 0.858 times in Grade A patients (OR = 0.142, 95%CI: 0.066–0.304, P < 0.001) and 0.804 times in Grade B patients (OR = 0.196, 95%CI: 0.085–0.451, P < 0.001) compared with patients without endoscopic primary prophylaxis, but showed no difference in Grade C patients.ConclusionEndoscopic primary prophylaxis was associated with a decreased risk of rebleeding in liver cirrhosis patients with EGVB after endoscopic therapy, which suggested that clinicians should pay more attention to endoscopic primary prophylaxis to prevent the occurrence of rebleeding in these patients.

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Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis

Abstract: Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis (Review)

Cited by 15 publications

References 345 publications

Analysis of Complications and Risk Factors Other than Bleeding before and after Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis

Analysis of Complications and Risk Factors Other than Bleeding before and after Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis

Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

Associations Between Endoscopic Primary Prophylaxis and Rebleeding in Liver Cirrhosis Patients with Esophagogastric Variceal Bleeding

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