Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis

Roberts, Danielle; Best, Lawrence; Freeman, Suzanne C.; Sutton, Alex J.; Cooper, Nicola J.; Arunan, Sivapatham; Begum, Tanjia; Williams, Norman; Walshaw, Dana; Milne, EJ; Tapp, Maxine; Csenar, Mario; Pavlov, Chavdar S; Davidson, Brian R; Tsochatzis, Emmanuel; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd013155.pub2

Cited by 19 publications

(8 citation statements)

References 294 publications

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“…Although the superiority of EVL over EIS for the secondary prophylaxis of variceal hemorrhage has been proven based on moderate-certainty evidence ( 11 ), the better emergency endoscopic treatment for acute EVB remains controversial. Lo GH, et al compared the short-term efficacy and safety of emergency EIS with EVL in the arresting of acute EVB.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are favored non-surgical treatment strategies of endoscopy for managing acute EVB ( 7 – 10 ). A newly published meta-analysis has demonstrated the superiority of EVL over EIS in terms of fewer adverse events ( 11 ). Several trials comparing long-term EIS to EVL gave separate data for EVB, however, failing to show any differences between the two ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study

et al. 2022

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Background and AimsEmergency endoscopy is recommended for patients with acute esophageal variceal bleeding (EVB) and their prognosis has improved markedly over past decades due to the increased specialization of endoscopic practice. The study aimed to compare outcomes following emergency endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) in cirrhotic patients with acute EVB.MethodsCirrhotic patients with acute EVB who underwent emergency endoscopy were retrospectively enrolled from 2013 to 2020 across 34 university hospitals from 30 cities. The primary outcome was the incidence of 5-day rebleeding after emergency endoscopy. Subgroup analysis was stratified by Child-Pugh class and bleeding history. A 1:1 propensity score matching (PSM) analysis was performed.ResultsA total of 1,017 and 382 patients were included in EIS group and EVL group, respectively. The 5-day rebleeding incidence was similar between EIS group and EVL group (4% vs. 5%, P = 0.45). The result remained the same after PSM (P = 1.00). Among Child-Pugh class A, B and C patients, there were no differences in the 5-day rebleeding incidence between the two groups after PSM (P = 0.25, 0.82, and 0.21, respectively). As for the patients with or without bleeding history, the differences between EIS group and EVL group were not significant after PSM (P = 1.00 and 0.26, respectively).ConclusionThe nationwide cohort study indicates that EIS and EVL are both efficient emergency endoscopic treatment strategies for acute EVB. EIS should not be dismissed as an economical and effective emergency endoscopic treatment strategy of acute EVB. ClincialTrials.gov number NCT04307264.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study

et al. 2022

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“…Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy have demonstrated in randomized controlled trials that their single overall outcome is better than other treatments, with decreased rebleeding, mortality, and variceal eradication; recent network meta-analysis and some multicenter retrospective studies have demonstrated EVL's superiority as a single treatment for active bleeding; the addition of other medical treatments could potentiate the overall results, such as the dual therapy of EVL and NSBB [ 56 , 59 ]. Transjugular intrahepatic portosystemic shunt (TIPS) has been shown to control and reduce some of the pathophysiology behind the BEV with high efficacy.…”

Section: Reviewmentioning

confidence: 99%

The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review

Murillo Pineda,

Siu Xiao,

Sanabria Herrera

et al. 2024

Cureus

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Esophageal varices (EVs), a significant complication of cirrhosis, present a considerable challenge in clinical practice due to their high risk of bleeding and associated morbidity and mortality. This manuscript explores the transformative role of artificial intelligence (AI) in the management of EV, particularly in enhancing diagnostic accuracy and predicting bleeding risks. It underscores the potential of AI in offering noninvasive, efficient alternatives to traditional diagnostic methods such as esophagogastroduodenoscopy (EGD). The complexity of EV management is highlighted, necessitating a multidisciplinary approach that includes pharmacological therapy, endoscopic interventions, and, in some cases, surgical options tailored to individual patient profiles. Additionally, the paper emphasizes the importance of integrating AI into medical education and practice, preparing healthcare professionals for the evolving landscape of medical technology. It projects a future where AI significantly influences the management of gastrointestinal bleeding, improving clinical decision-making, patient outcomes, and overall healthcare efficiency. The study advocates for a patient-centered approach in healthcare, balancing the incorporation of innovative technologies with ethical principles and the diverse needs of patients to optimize treatment efficacy and enhance healthcare accessibility.

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“…Ainda à nível de tratamento, ficou claro que os procedimentos cirúrgicos são recomendados num plano terciário, sendo mais utilizadas em casos específicos em que haja indicação, priorizando os tratamentos conservadores prezando assim pela qualidade de vida de cada paciente, corroborando com (Roberts, 2021).…”

Section: Conclusãounclassified

Aspectos epidemiológicos do tratamento cirúrgico das varizes esofágicas entre 2016-2020 no Brasil

Santos

Oliveira

Silva

et al. 2022

RSD

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A prevalência de varizes esofágicas tem aumentado no Brasil ao decorrer dos anos, e alguns aspectos epidemiológicos mantém relação com esse fato, impactando na modalidade cirúrgica de seu tratamento. Objetivo: O estudo objetivou determinar quais aspectos epidemiológicos e seus impactos sobre o tratamento cirúrgico de varizes esofágicas, além da sua relação com a quantidade de internações e óbitos. Justificativa: Devido a essa patologia ser em grande parte atendido como caráter de urgência, evitar e diminuir o sangramento das varizes esofágicas com os procedimentos cirúrgicos envolvidos são importantes na sobrevida do paciente. Dessa forma, o presente estudo traz uma necessidade de maior compreensão sobre o tema, uma vez que, há uma carência de informações mais recentes e de estudos acadêmicos mais atualizados relacionados ao assunto. Resultados: a quantidade de casos durante o período de 2016-2020 aumentou, ficando evidente o aumento no número de internações, durante esse mesmo período segundo o estudo realizado o caráter mais prevalente de atendimento nesses casos foi o de urgência representando boa parte dos casos, os resultados também demonstraram que a taxa de mortalidade vem caindo com o passar dos anos. Conclusão: em virtude do apresentado o perfil epidemiológico encontrado como prevalente é masculino, pardo, idade acima de 60 anos e escolaridade menor que 7 anos. Além disso, é possível concluir que apesar de existirem diversos tratamentos para varizes esofágicas, os procedimentos cirúrgicos têm papel de destaque nos pacientes que apresentaram falha terapêutica em tratamentos mais conservadores.

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Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis

Abstract: Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis.

Cited by 19 publications

References 294 publications

Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study

Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study

The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review

Aspectos epidemiológicos do tratamento cirúrgico das varizes esofágicas entre 2016-2020 no Brasil

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