Self-expandable metallic stents (SEMS) in esophageal varices post-band ulcer refractory bleeding: a retrospective study

Abstract

Background Post-variceal band ligation bleeding ulcer is a severe complication with considerable mortality. We tried evaluating self-expandable metallic stent (SEMS) with concern to the ulcer morphology not well studied. Results We did a retrospective analysis of patients with bleeding post-band ulcers and treated by SEMS with concern to control bleeding and 6 weeks survival. Twenty-eight patients studied had their age (mean ± S.D.) 57.8 ± 8.6 years, and 85.7% were males. The Child-Pugh score range was 5–12]. Control of bleeding by SEMS was achieved in 23 (82.1%) patients, and overall, 6-week survival was 75%. Both post-band ulcer types B (oozing blood and type C (active spurted) were a risk for 6 weeks mortality (P = 0.04, OR 1.58, CI 95% 1.12–2.23). Conclusion SEMS is considered an excellent choice to control esophageal post-banding ulcer bleeding and a definite treatment bridge.

Predictors and management of post‐banding ulcer bleeding in cirrhosis: A systematic review and meta‐analysis

“…Studies were classified in high quality if ≥7 points, moderate quality if 5–6 points and low quality if ≤4 points. Thirteen studies were classified into high quality, 4,5,7,8,11–18 four studies were at moderate risk of Bias 19–22 . Cochrane's ROB 2 Risk of Bias Tool was used to assess the risk of bias in two randomized controlled trials (Table S4).…”

“…Thirteen studies were classified into high quality, 4,5,7,8,[11][12][13][14][15][16][17][18] four studies were at moderate risk of Bias. [19][20][21][22] Cochrane's ROB 2 Risk of Bias Tool was used to assess the risk of bias in two randomized controlled trials (Table S4). These two included studies were at low risk of Bias.…”

“…5,12,[14][15][16]19,23,24 Other types of endoscopic therapies were used as well (argon plasma coagulation, oesophageal variceal obliteration, like sclerotherapy and cyanoacrylate injection, epinephrine injection, hemoclip). In case of refractory bleeding, oesophageal selfexpandable metallic stent (SEMS) was employed in two studies, 14,22 and oesophageal balloon tamponade in six studies. 5,7,14,15,21,22 TIPS was used in severe bleeding in five studies 5,7,14,16,24 but the number of patients treated were reported only in three studies: one study 7 reported two patients receiving an emergency TIPS; in the second study, 16 TIPS was used successfully as initial treatment in two patients, and as a rescue treatment in four patients, and was successful in 3; in the third study 14 TIPS was performed in 19 patients, of whom 9 survived and 8 died despite TIPS.…”

“…Eighteen studies were included in the systematic review (Figure 1) of which 14 were retrospective observational studies, 5,7,8,[11][12][13][14][15][16][17][18][19]21,22 four studies were prospective, with two prospective observational studies 4,20 and two randomized controlled trials. 23,24 The main study characteristics are provided in Table S5.…”

“…The indication for EBL was elective (primary and/or secondary prophylaxis) in three studies, 12,21,23 urgent treatment of active variceal bleeding in one study, 22 and both elective prophylaxis and urgent treatment of acute variceal bleeding in 14 studies. 4,5,7,8,11,[13][14][15][16][17][18][19][20]22,24 Sixteen included studies were unicentric and two were multicentric studies. 12,14 Overall, these studies included a total of 9043 patients, 6819 (75.4%) male and 2224 (24.6%) female.…”