Emergency sclerotherapy versus vasoactive drugs for bleeding oesophageal varices in cirrhotic patients

D’Amico, Gennaro; Pagliaro, Luigi; Pietrosi, Giada; Tarantino, Ilaria

doi:10.1002/14651858.cd002233.pub2

Cited by 41 publications

(22 citation statements)

References 64 publications

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“…In general, it has been a challenge to demonstrate that many common interventions provided to cirrhotic patients with variceal haemorrhage have superior survival results in comparison trials. 20 Second, we cannot say which of our interventions (the educational sessions or the order set) had a larger effect on our results. Although we suspect that the order set was the key influence in the improvement in care, randomisation of the use of the order set may have been able to better demonstrate that it was the main driver in changing physician behaviour compared with the educational sessions.…”

Section: Discussionmentioning

confidence: 85%

Optimising the care of patients with cirrhosis and gastrointestinal haemorrhage: a quality improvement study

Johnson

Spier

Leff

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

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Section: Discussionmentioning

confidence: 85%

Optimising the care of patients with cirrhosis and gastrointestinal haemorrhage: a quality improvement study

Johnson

Spier

Leff

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

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“…Death for post-ES complications may occur in 2% of patients [66] . In a Cochrane meta-analysis ES was not shown to be superior to the vasoactive drug therapy for the control of bleeding, rebleeding, and mortality [67] .…”

Section: Endoscopic Sclerotherapy (Es)mentioning

confidence: 94%

Endoscopic Management of Variceal Haemorrhage

Dell’Era

Iannuzzi

Franchis

2015

Journal of Gastroenterology and Hepatology Research

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One of the most important complications of portal hypertension, in the setting of liver cirrhosis or of non-cirrhotic portal hypertension, is upper gastrointestinal bleeding from ruptured gastroesophageal varices and portal hypertensive gastropathy. The management of the acute variceal bleeding is a multidisciplinary process that includes the initial assessment of the patient, effective resuscitation, timely diagnosis, control of bleeding and prevention of early rebleeding and complications such as infection, hepatorenal syndrome, or hepatic encephalopathy. Antibiotic prophylaxis, conservative targets for blood transfusions and combination therapy with vasoactive drugs and endoscopic treatments are the first-line measures in the management of acute variceal bleeding; transjugular intrahepatic portosystemic shunts should be proposed early to high-risk patients or as a rescue therapy for those who fail first-line treatment.

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“…Several previous meta‐analyses have investigated the role of vasoactive pharmacological agents in patients with acute oesophageal bleeds . However, these publications have important limitations.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis: vasoactive medications for the management of acute variceal bleeds

Wells

Chande

Adams

et al. 2012

Aliment Pharmacol Ther

213

136

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Summary Background Vasoactive medications such as vasopressin, somatostatin and their analogues (terlipressin, vapreotide and octreotide) are commonly used for the treatment of acute variceal bleeding. However, the risks and benefits of these interventions are not well understood. Aim To undertake a meta‐analysis of the efficacy of vasoactive medications in patients having acute variceal bleeds. Methods Randomised controlled trials (RCTs) of vasopressin, somatostatin and their analogues, administered to patients with acute variceal bleeds were identified based on systematic searches of nine electronic databases and multiple sources of grey literature. Results The search identified 3011 citations, and 30 trials with a total of 3111 patients met eligibility criteria. The use of vasoactive agents was associated with a significantly lower risk of 7‐day mortality (RR 0.74; 95% CI 0.57–0.95; P = 0.02; I2 = 0%; moderate quality of evidence), and a significant improvement in haemostasis (RR 1.21, 95% CI 1.13–1.30; P < 0.001; I2 = 28%; very low quality of evidence), lower transfusion requirements (pooled mean difference −0.70 units of blood transfused, 95% CI −1.01 to −0.38; P < 0.001; I2 = 82%; moderate quality of evidence), and a shorter duration of hospitalisation (pooled mean difference −0.71 days; 95% CI −1.23 to −0.19; P = 0.007; I2 = 0%; low quality of evidence). Studies comparing different vasoactive agents did not show a difference in efficacy, although the quality of evidence was very low. Conclusions The use of vasoactive agents was associated with a significantly lower risk of acute all‐cause mortality and transfusion requirements, and improved control of bleeding and shorter hospital stay. Studies comparing different vasoactive medications failed to demonstrate a difference in efficacy.

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Emergency sclerotherapy versus vasoactive drugs for bleeding oesophageal varices in cirrhotic patients

Abstract: Emergency sclerotherapy versus vasoactive drugs for bleeding oesophageal varices in cirrhotic patients.

Cited by 41 publications

References 64 publications

Optimising the care of patients with cirrhosis and gastrointestinal haemorrhage: a quality improvement study

Optimising the care of patients with cirrhosis and gastrointestinal haemorrhage: a quality improvement study

Endoscopic Management of Variceal Haemorrhage

Meta‐analysis: vasoactive medications for the management of acute variceal bleeds

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