A Multicenter Evaluation of Adherence to 4 Major Elements of the Baveno Guidelines and Outcomes for Patients With Acute Variceal Hemorrhage

Tapper, Elliot B.; Friderici, Jennifer; Borman, Zachary A.; Alexander, Jacob; Bonder, Alan; Nuruzzaman, Nabiha; Ramdass, Sheryl; Ghaoui, Rony

doi:10.1097/mcg.0000000000000820

Cited by 16 publications

(11 citation statements)

References 29 publications

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“…Among the patients with MELD score ≤17, early endoscopy could have worse outcomes than delayed endoscopy [21]. According to the present work, only four studies [8,[19][20][21] clearly demonstrated that the baseline characteristics of patients were not significantly different between early and delayed endoscopy groups, but the remaining five studies [7,[15][16][17][18] did not mention the difference in the severity of liver dysfunction between the two groups, which might lead to a potential bias in the statistical results. Additionally, we could not extract any relevant data to stratify the impact of timing of endoscopy on the basis of the severity of liver cirrhosis.…”

Section: Discussionmentioning

confidence: 64%

“…Chen et al showed that early endoscopy had lower 6-week mortality than delayed endoscopy in the hematemesis group; contrarily, the 6-week mortality was similar between them in the nonhematemesis group [7]. Of our included studies, 2 clearly reported the proportion of hematemesis in each group [20,21], 3 just reported the proportion of hematemesis in total patients [7,8,15], and 4 did not mention the manifestations of AVB [16][17][18][19]. Thus, the present meta-analysis could not explore the impact of timing of endoscopy in patients with different manifestations of AVB.…”

Section: Discussionmentioning

confidence: 99%

“…Overall analysis Nine studies including 2824 patients explored the mortality after early and delayed endoscopy [7,8,[15][16][17][18][19][20][21] (Table 2). Meta-analysis showed that the overall mortality was significantly lower in early endoscopy group than delayed endoscopy group (OR = 0.56, 95% CI, 0.33-0.95, P = 0.03).…”

Section: Overall Mortalitymentioning

confidence: 99%

“…Six studies including 2290 patients defined the timing of endoscopy <12 h as early endoscopy [7,8,[17][18][19]21] (Table 2). Meta-analysis showed that the difference in the overall mortality was NS between early and delayed endoscopy groups (OR = 0.72, 95% CI, 0.38-1.38, P = 0.33).…”

Section: Subgroup Analysis Of Studies With Early Endoscopy Defined As...mentioning

confidence: 99%

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Outcomes of early versus delayed endoscopy in cirrhotic patients with acute variceal bleeding: a systematic review with meta-analysis

Bai

Wang

Cheng

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Overall Mortalitymentioning

confidence: 99%

Section: Subgroup Analysis Of Studies With Early Endoscopy Defined As...mentioning

confidence: 99%

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Outcomes of early versus delayed endoscopy in cirrhotic patients with acute variceal bleeding: a systematic review with meta-analysis

Bai

Wang

Cheng

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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“…It has been reported that cirrhotic patients who receive a treatment adherent to CPG recommendations could benefit from good therapeutic efficacy [ 7 ]. Moreover, a multicenter evaluation study found that adherence to Baveno CPGs could improve the clinical outcomes of patients with acute variceal haemorrhage [ 8 ]. Several CPGs have been developed for the management of bacterial infections in patients with cirrhosis or liver failure.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure

et al. 2022

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Background Bacterial infections are common complications in patients with cirrhosis or liver failure and are correlated with high mortality. Clinical practice guideline (CPG) is a reference used to help clinicians make decisions. This systematic appraisal aimed to evaluate the methodological quality and summarize the recommendations of reported CPGs in these patients. Methods We systematically searched CPGs published from 2008 to 2019. The methodological quality of the included CPGs was assessed using the AGREE II instrument. We extracted and compared recommendations for prophylactic and empirical treatment strategies. Results Fourteen CPGs with a median overall score of 56.3% were included. The highest domain score was Clarity of Presentation (domain 4, 85.4%), and the lowest was for Stakeholder Involvement (domain 2, 31.3%). Three CPGs had an overall score above 80%, and 6 CPGs had a score above 90% in domain 4. Prophylaxis should be strictly limited to patients with varicose bleeding, low ascites protein levels and a history of spontaneous bacterial peritonitis. Fluoroquinolones (norfloxacin and ciprofloxacin), third-generation cephalosporins (G3) (ceftriaxone and cefotaxime) and trimethoprim–sulfamethoxazole (SXT) are recommended for preventing infections in patients with cirrhosis or liver failure. G3, β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems are recommended as the first choice in empirical treatment according to local epidemiology of bacterial resistance. Conclusions The methodological quality of CPGs focused on patients with cirrhosis or liver failure evaluated by the AGREE II instrument is generally poor. Three CPGs that were considered applicable without modification and 6 CPGs that scored above 90% in domain 4 should also be paid more attention to by healthcare practitioners. Regarding recommendations, norfloxacin, ciprofloxacin, ceftriaxone, cefotaxime, and SXT are recommended for prophylactic treatment appropriately. G3, BLBLIs, and carbapenems are recommended for use in empirical treatment strategies.

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Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China

Wang,

Hu,

et al. 2024

Portal Hypertension & Cirrhosis

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AimsThe endoscopic treatment of esophagogastric varices is challenging, and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains unclear. This study investigated the use of endoscopic therapy for portal hypertension in China.MethodsThis study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension. Questionnaires were released online from January 30, 2023 to February 28, 2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces (autonomous regions and municipalities) in China. Comparisons of guideline adherence between primary and referral medical centers were performed using the chi‐square test or Fisher's exact test.ResultsIn total, 836 hospitals participated in the survey. For primary and secondary prophylaxis of esophagogastric variceal bleeding (EGVB), adherence to the national guidelines was 72.5% (606/836) and 39.2% (328/836), respectively. Significant differences were observed in the rate of adherence between the primary and referral centers for primary (79.9% [111/139] vs. 71.0% [495/697], p = 0.033) and secondary prophylaxis (27.3% [38/139] vs. 41.6% [290/697], p = 0.002). Of the hospitals, 78.2% (654/836) preferred endoscopic therapies for acute EGVB, and the timing of endoscopy was usually within 12 h (48.5%, 317/654) and 12–24 h (36.9%, 241/654) after bleeding. Endoscopic therapy was more likely to be the first choice of treatment for acute EGVB in referral centers than in primary centers (82.6% [576/697] vs. 56.1% [78/139], p < 0.001). Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, the most prevalent procedures were cyanoacrylate injection combined with sclerotherapy (48.2% [403/836] and 29.9% [250/836], respectively); however, substantial hospitals preferred clip‐assisted therapies (12.4% [104/836] and 26.4% [221/836], respectively). Nonselective beta‐blockers were routinely used in 73.4% (614/836) of hospitals during the perioperative period of EGVB management, and propranolol (88.8%, 545/614) and carvedilol (37.5%, 230/614) were the most widely used nonselective beta‐blockers.ConclusionsThis survey clarified that various endoscopic procedures have been implemented nationwide in China. Participating hospitals have actively performed emergent endoscopy for acute EGVB; however, these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB. In the future, standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial.

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A Multicenter Evaluation of Adherence to 4 Major Elements of the Baveno Guidelines and Outcomes for Patients With Acute Variceal Hemorrhage

Abstract: Adherence to quality metrics may not reduce the risk of mortality but could improve secondary outcomes of AVH. Variation in practice should be addressed through quality improvement interventions.

Cited by 16 publications

References 29 publications

Outcomes of early versus delayed endoscopy in cirrhotic patients with acute variceal bleeding: a systematic review with meta-analysis

Outcomes of early versus delayed endoscopy in cirrhotic patients with acute variceal bleeding: a systematic review with meta-analysis

Evaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure

Nationwide survey analysis of esophagogastric varices in portal hypertension based on endoscopic management in China

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