&lt;p&gt;Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis&lt;/p&gt;

Tian, Shan; Li, Ruixue; Guo, Ying; Jia, Xuemei; Dong, Weiguo

doi:10.2147/tcrm.s193196

Cited by 6 publications

(6 citation statements)

References 27 publications

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Section: Endoscopic Screening For High Risk Esophagogastric Varices A...mentioning

confidence: 79%

“…reported no significant difference in variceal bleeding between the carvedilol and EBL groups (RR 0.86, 95 %CI 0.60 to 1.23). Moreover, no significant difference was observed for all-cause mortality (RR 0.82, 95 %CI 0.44 to 1.53) or for bleeding-related deaths (RR 0.85, 95 %CI 0.39 to 1.87)[18]. ESGE recommends that, in those patients unable to receive NSBB therapy with a screening upper GI endoscopy that does not demonstrate high risk varices, surveillance endoscopy should be performed every 2 years if there is ongoing active liver disease or every 3 years if the underlying liver disease is quiescent.…”

mentioning

confidence: 83%

“…There have been several systematic reviews/meta-analyses of RCTs evaluating the benefits and harms of EBL versus NSBBs as primary prophylaxis for esophageal variceal bleeding [16][17][18]. In a Cochrane systematic review, Gluud et al reported that 176/731 of the patients randomized to EBL (24 %) and 177/773 of patients randomized to NSBBs (23 %) died.…”

Section: Primary Prophylaxis For Esophagogastric Variceal Hemorrhagementioning

confidence: 99%

“…In the most recent systematic review/meta-analysis evaluating carvedilol versus EBL, Tian et al reported no significant difference in variceal bleeding between the carvedilol and EBL groups (RR 0.86, 95 %CI 0.60 to 1.23). Moreover, no significant difference was observed for all-cause mortality (RR 0.82, 95 %CI 0.44 to 1.53) or for bleeding-related deaths (RR 0.85, 95 %CI 0.39 to 1.87) [18]. 4 Pre-endoscopy management of acute EGVH The goals of hemodynamic resuscitation are to correct intravascular hypovolemia, restore adequate tissue perfusion, and prevent multiorgan failure.…”

Section: Primary Prophylaxis For Esophagogastric Variceal Hemorrhagementioning

confidence: 99%

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Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2022

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Main Recommendations 1 ESGE recommends that patients with compensated advanced chronic liver disease (ACLD; due to viruses, alcohol, and/or nonobese [BMI < 30 kg/m2] nonalcoholic steatohepatitis) and clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] > 10 mmHg and/or liver stiffness by transient elastography > 25 kPa) should receive, if no contraindications, nonselective beta blocker (NSBB) therapy (preferably carvedilol) to prevent the development of variceal bleeding.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in those patients unable to receive NSBB therapy with a screening upper gastrointestinal (GI) endoscopy that demonstrates high risk esophageal varices, endoscopic band ligation (EBL) is the endoscopic prophylactic treatment of choice. EBL should be repeated every 2–4 weeks until variceal eradication is achieved. Thereafter, surveillance EGD should be performed every 3–6 months in the first year following eradication.Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute upper GI hemorrhage (UGIH) and no history of cardiovascular disease, a restrictive red blood cell (RBC) transfusion strategy, with a hemoglobin threshold of ≤ 70 g/L prompting RBC transfusion. A post-transfusion target hemoglobin of 70–90 g/L is desired.Strong recommendation, moderate quality evidence. 4 ESGE recommends that patients with ACLD presenting with suspected acute variceal bleeding be risk stratified according to the Child–Pugh score and MELD score, and by documentation of active/inactive bleeding at the time of upper GI endoscopy.Strong recommendation, high quality of evidence. 5 ESGE recommends the vasoactive agents terlipressin, octreotide, or somatostatin be initiated at the time of presentation in patients with suspected acute variceal bleeding and be continued for a duration of up to 5 days.Strong recommendation, high quality evidence. 6 ESGE recommends antibiotic prophylaxis using ceftriaxone 1 g/day for up to 7 days for all patients with ACLD presenting with acute variceal hemorrhage, or in accordance with local antibiotic resistance and patient allergies.Strong recommendation, high quality evidence. 7 ESGE recommends, in the absence of contraindications, intravenous erythromycin 250 mg be given 30–120 minutes prior to upper GI endoscopy in patients with suspected acute variceal hemorrhage.Strong recommendation, high quality evidence. 8 ESGE recommends that, in patients with suspected variceal hemorrhage, endoscopic evaluation should take place within 12 hours from the time of patient presentation provided the patient has been hemodynamically resuscitated.Strong recommendation, moderate quality evidence. 9 ESGE recommends EBL for the treatment of acute esophageal variceal hemorrhage (EVH).Strong recommendation, high quality evidence. 10 ESGE recommends that, in patients at high risk for recurrent esophageal variceal bleeding following successful endoscopic hemostasis (Child–Pugh C ≤ 13 or Child–Pugh B > 7 with active EVH at the time of endoscopy despite vasoactive agents, or HVPG > 20 mmHg), pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) within 72 hours (preferably within 24 hours) must be considered.Strong recommendation, high quality evidence. 11 ESGE recommends that, for persistent esophageal variceal bleeding despite vasoactive pharmacological and endoscopic hemostasis therapy, urgent rescue TIPS should be considered (where available).Strong recommendation, moderate quality evidence. 12 ESGE recommends endoscopic cyanoacrylate injection for acute gastric (cardiofundal) variceal (GOV2, IGV1) hemorrhage.Strong recommendation, high quality evidence. 13 ESGE recommends endoscopic cyanoacrylate injection or EBL in patients with GOV1-specific bleeding.Strong recommendations, moderate quality evidence. 14 ESGE suggests urgent rescue TIPS or balloon-occluded retrograde transvenous obliteration (BRTO) for gastric variceal bleeding when there is a failure of endoscopic hemostasis or early recurrent bleeding.Weak recommendation, low quality evidence. 15 ESGE recommends that patients who have undergone EBL for acute EVH should be scheduled for follow-up EBLs at 1- to 4-weekly intervals to eradicate esophageal varices (secondary prophylaxis).Strong recommendation, moderate quality evidence. 16 ESGE recommends the use of NSBBs (propranolol or carvedilol) in combination with endoscopic therapy for secondary prophylaxis in EVH in patients with ACLD.Strong recommendation, high quality evidence.

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Section: Endoscopic Screening For High Risk Esophagogastric Varices A...mentioning

confidence: 79%

mentioning

confidence: 83%

Section: Primary Prophylaxis For Esophagogastric Variceal Hemorrhagementioning

confidence: 99%

Section: Primary Prophylaxis For Esophagogastric Variceal Hemorrhagementioning

confidence: 99%

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Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2022

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“…Treatment with NSBBs (propranolol, nadolol, or carvedilol) should be considered for the prevention of decompensation in patients with CSPH. In particular, carvedilol should be preferred as the first choice in compensated cirrhosis [ 10 ], since it is more effective at reducing HVPG and preventing decompensation, has better tolerance than traditional NSBBs, and has been demonstrated to improve survival [ 26 ].…”

Section: Prevention and Management Of Variceal Bleedingmentioning

confidence: 99%

Diagnosis and Management of Esophagogastric Varices

et al. 2023

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Acute variceal bleeding (AVB) is a potentially fatal complication of clinically significant portal hypertension and is one of the most common causes of acute upper gastrointestinal bleeding. Thus, esophagogastric varices represent a major economic and population health issue. Patients with advanced chronic liver disease typically undergo an upper endoscopy to screen for esophagogastric varices. However, upper endoscopy is not recommended for patients with liver stiffness < 20 KPa and platelet count > 150 × 109/L as there is a low probability of high-risk varices. Patients with high-risk varices should receive primary prophylaxis with either nonselective beta-blockers or endoscopic band ligation. In cases of AVB, patients should receive upper endoscopy within 12 h after resuscitation and hemodynamic stability, whereas endoscopy should be performed as soon as possible if patients are unstable. In cases of suspected variceal bleeding, starting vasoactive therapy as soon as possible in combination with endoscopic treatment is recommended. On the other hand, in cases of uncontrolled bleeding, balloon tamponade or self-expandable metal stents can be used as a bridge to more definitive therapy such as transjugular intrahepatic portosystemic shunt. This article aims to offer a comprehensive review of recommendations from international guidelines as well as recent updates on the management of esophagogastric varices.

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Endoscopic Management of Variceal Bleeding

Αγγελετοπούλου¹,

Triantos²

2020

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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<p>Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis</p>

Cited by 6 publications

References 27 publications

Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diagnosis and Management of Esophagogastric Varices

Endoscopic Management of Variceal Bleeding

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