Secondary Prophylaxis of Gastric Variceal Bleeding: A Systematic Review and Network Meta‐Analysis

Osman, Karim; Nayfeh, Tarek; Abdelfattah, Ahmed; Alabdallah, Khaled; Hasan, Bashar; Firwana, Mohammed; Alabaji, Homam; Elkhabiry, Lina; Mousa, Jehan; Prokop, Larry J.; Murad, Mohammad Hassan; Gordon, Fredric D.

doi:10.1002/lt.26383

Cited by 18 publications

(13 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, NSBB therapy alone did not demonstrate a benefit in terms of preventing gastric variceal rebleeding compared with most interventions, nor reduce mortality compared with endoscopic injection of cyanoacrylate alone (RR 4.12, 95 %CI 1.50 to 11.36) and endoscopic injection of cyanoacrylate plus NSBB (RR 5.61, 95 %CI 1.91 to 16.43). This study suggested that BRTO may be the best intervention in preventing gastric variceal rebleeding (secondary prophylaxis), whereas an NSBB given as monotherapy cannot be recommended; however, head-to-head direct comparator studies are much needed 132 .…”

Section: Post-endoscopy Managementmentioning

confidence: 99%

“…In addition, a recently published network meta-analysis (nine RCTs with 647 patients who had a history of GVH and follow-up of more than 6 weeks) compared the efficacy of available secondary prophylaxis treatments [132]. BRTO was associated with a lower risk of rebleeding when compared with NSBB therapy alone (RR 0.04, 95 %CI 0.01 to 0.26) and endoscopic injection of cyanoacrylate alone (RR 0.18, 95 %CI 0.04 to 0.77).…”

Section: Secondary Prophylaxis: Prevention Of Recurrent Esophageal Or...mentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Post-endoscopy Managementmentioning

confidence: 99%

Section: Secondary Prophylaxis: Prevention Of Recurrent Esophageal Or...mentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Втручання включали призначення НСББ, БРТО, ЕІЦ, ендоскопічне лігування варикозних вен, ендоскопічну склеротерапію під контролем EУСГ-ЕІЦ, ТВПШ. БРТО виявилася найкращим заходом для запобігання повторній кровотечі, тоді як монотерапія β-блокаторами -найгіршим [49].…”

Section: вторинна профілактика кровотечі зі шлункових вариксівunclassified

Comprehensive treatment of patients with gastric variceal bleeding

Chooklin

Chuklin²

2022

ЕМ

View full text Add to dashboard Cite

Gastro-oesophageal varices are the major clinical manifestations of cirrhosis and portal hypertension. Bleeding from gastric varices is usually severe and is associated with higher mortality and a higher risk of rebleeding than from esophageal varices. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiological interventions. In terms of treatment, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires prompt intervention to stop it and achieve long-term hemostasis. This review describes the features of pharmacological, endoscopic and interventional radiological prophylactic and treatment options in gastric variceal bleeding. We searched the literature in the MedLine database on the PubMed platform.

show abstract

“…Advances in endoscopic treatment have enabled the safe and effective treatment of esophageal varices. By contrast, gastric varices (GV) are often technically difficult to treat endoscopically, and additional or alternative treatments are required to achieve complete hemostasis of bleeding from GV [[2]–[4]].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Prognosis and Related Factors in Patients with Cirrhosis Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Tamura

Asaoka

Takeuchi

et al. 2023

Dig Dis

View full text Add to dashboard Cite

Introduction: Balloon-occluded retrograde transvenous obliteration (BRTO) was developed as an effective treatment for gastric varices in patients with cirrhosis. Because liver fibrosis in these patients is assumed to be advanced, their prognosis is expected to be poor. In this study, we investigated the prognosis and characteristics of the patients. Methods: We enrolled 55 consecutive patients with liver cirrhosis treated with BRTO between 2009 and 2021 at our department. To evaluate factors related to variceal recurrence and long-term prognosis, survival analysis was performed on 45 patients, excluding those who died within 1 month, had an unknown prognosis, or whose treatments were converted to other treatments. Results: During a mean follow-up period of 2.3 years, esophageal varices recurred in 10 patients and could be treated endoscopically. Non-alcoholic steatohepatitis (NASH) was related to the variceal recurrence (hazard ratio [HR] = 4.27, 95% CI: 1.17–15.5, p = 0.028). The survival rate after the procedure at 1, 3, and 5 years was 94.2%, 74.0%, and 63.5%, respectively, and 10 patients died of hepatocellular carcinoma (n = 6), liver failure (n = 1), sepsis (n = 1), and unknown reasons (n = 2). The estimated glomerular filtration rate (eGFR) level was proved to be a significant poor prognostic factor (HR = 0.96, 95% CI: 0.93–0.99, p = 0.023). The comorbid hypertension (HTN) was the main cause of low eGFR, and HTN was also significantly related to survival (HR = 6.18, 95% CI: 1.57–24.3, p = 0.009). Most of the patients with HTN were treated with calcium channel blocker and/or angiotensin receptor blocker. Conclusion: The clinical course of patients with cirrhosis treated with BRTO was dependent on the metabolic factors including renal function, comorbid HTN, and NASH.

show abstract

Secondary Prophylaxis of Gastric Variceal Bleeding: A Systematic Review and Network Meta‐Analysis

Cited by 18 publications

References 51 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

Comprehensive treatment of patients with gastric variceal bleeding

Long-Term Prognosis and Related Factors in Patients with Cirrhosis Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Contact Info

Product

Resources

About