scholarly journals Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis

2016 ◽  
Vol 28 (5) ◽  
pp. 539-547 ◽  
Author(s):  
Thomas R McCarty ◽  
Basile Njei
Keyword(s):  
Systematic Review ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Metal Stents ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Self Expanding Metal Stents

scholarly journals Short-course vasoconstrictors are adequate for esophageal variceal bleeding after endoscopic variceal ligation: A systematic review and meta-analysis

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110317
Author(s):  
Jen-Hao Yeh ◽  
Gin-Ho Lo ◽  
Ru-Yi Huang ◽  
Chih-Wen Lin ◽  
Wen-Lun Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Endoscopic Variceal Ligation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Short Course ◽  
Significant Difference

Endoscopic variceal ligation (EVL) with vasoconstrictors has been recommended for acute esophageal variceal bleeding. However, the optimal duration of vasoconstrictors after EVL is controversial. This systematic review and meta-analysis was conducted to explore the efficacy of short-course vasoconstrictors (≤3 days) versus standard combination (3–5 days). A comprehensive literature review was conducted using the PubMed, Embase, and Cochrane library databases with subsequent meta-analysis. The primary outcomes were 5-day rebleeding, mortality, and treatment failure rates. A risk ratio (RR) with 95% confidence interval is used for outcome comparison. Nine randomized studies with 838 patients were included. The initial hemostasis (96.8% vs 97.4%, p = 0.919), 5-day rebleeding (11.2% vs 8.3%, RR = 1.05, 95% CI = 0.62–1.76), mortality (0 vs 1.3%, RR = 0.48, 95% CI = 0.10–2.39), and treatment failure (7.4% vs 5.9%, RR = 1.10, 95% CI = 0.48–2.49) were similar in both groups. Subgroup analysis suggested EVL alone had no significant difference of 5-day re-bleeding (15.9% vs 7.1%, RR = 2.25, 95% CI = 0.87–5.77), mortality (0 vs 0.7%, RR = 0.71, 95% CI = 0.08–6.03), treatment failure (9.6% vs 6.7%, RR = 1.43, 95% CI = 0.54–3.75) compared to standard combination. Clinical heterogeneity was found for the rebleeding rate for the subgroup during sensitivity analysis. EVL with short-course vasoconstrictors is highly efficacious for esophageal variceal bleeding. Further studies are required to determine the genuine need of subsequent vasoconstrictor after successful EVL.

scholarly journals Mo1531 – Early (Pre-Emptive) Tips Versus Conventional Treatment for Prophylaxis of Esophageal Variceal Bleeding: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 156 (6) ◽  
pp. S-1333-S-1334
Author(s):  
Shadi Hamdeh ◽  
Osama Altayar ◽  
Muhammad Aziz ◽  
Jihan Fathallah ◽  
Mojtaba S. Olyaee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Variceal Bleeding ◽  
Conventional Treatment ◽  
Meta Analysis ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Balloon Tamponade and Esophageal Stenting for Esophageal Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 39 (02) ◽  
pp. 178-194 ◽  
Author(s):  
Susana Rodrigues ◽  
Andrés Cárdenas ◽  
Àngels Escorsell ◽  
Jaime Bosch
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Balloon Tamponade ◽  
Acute Variceal Bleeding

AbstractFailure to control variceal bleeding with current recommendations occurs in 10 to 20% of cases. This systematic review and meta-analysis analyzes the experience, results, and complications of “bridge” therapies for failure to control acute variceal bleeding: balloon tamponade and esophageal stents. The main outcomes assessed were failure to control bleeding and mortality in the short-term and medium-term follow-up, and adverse events. Balloon tamponade studies had a pooled rate of short-term failure to control bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death. Stenting failed to control bleeding in the short term and medium term in 12.7 and 21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies. Although only one trial compared these treatments, the available evidence consistently supports that stents serve as a better and safer bridge therapy in refractory acute variceal bleeding.

The use of self-expanding metal stents to treat acute esophageal variceal bleeding

Endoscopy ◽  
2006 ◽  
Vol 38 (9) ◽  
pp. 896-901 ◽  
Author(s):  
R. Hubmann ◽  
G. Bodlaj ◽  
M. Czompo ◽  
L. Benkö ◽  
P. Pichler ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Metal Stents ◽  
Use Of Self ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Self Expanding Metal Stents

scholarly journals Efficacy of endoscopic treatments for acute esophageal variceal bleeding in cirrhotic patients: systematic review and meta-analysis

2019 ◽  
Vol 07 (11) ◽  
pp. E1503-E1514 ◽  
Author(s):  
Fernanda de Quadros Onofrio ◽  
Julio Carlos Pereira-Lima ◽  
Felipe Marquezi Valença ◽  
André Luis Ferreira Azeredo-da-Silva ◽  
Airton Tetelbom Stein
Keyword(s):  
Systematic Review ◽  
Variceal Bleeding ◽  
Control Measure ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Esophageal Resection ◽  
Bleeding Control ◽  
Vasoactive Drugs ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Abstract Background and aim Guidelines recommend use of ligation and vasoactive drugs as first-line therapy and as grade A evidence for acute variceal bleeding (AVB), although Western studies about this issue are lacking. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of endoscopic treatments for AVB in patients with cirrhosis. Trials that included patients with hepatocellular carcinoma, use of portocaval shunts or esophageal resection, balloon tamponade as first bleeding control measure, or that received placebo or elective treatment in one study arm were excluded. Results A total of 8382 publications were searched, of which 36 RCTs with 3593 patients were included. Ligation was associated with a significant improvement in bleeding control (relative risk [RR] 1.08; 95 % confidence interval [CI] 1.02 – 1.15) when compared to sclerotherapy. Sclerotherapy combined with vasoactive drugs showed higher efficacy in active bleeding control compared to sclerotherapy alone (RR 1.17; 95 % CI 1.10 – 1.25). The combination of ligation and vasoactive drugs was not superior to ligation alone in terms of overall rebleeding (RR 2.21; 95 %CI 0.55 – 8.92) and in-hospital mortality (RR 1.97; 95 %CI 0.78 – 4.97). Other treatments did not generate meta-analysis. Conclusions This study showed that ligation is superior to sclerotherapy, although with moderate heterogeneity. The combination of sclerotherapy and vasoactive drugs was more effective than sclerotherapy alone. Although current guidelines recommend combined use of ligation with vasoactive drugs in treatment of esophageal variceal bleeding, this study failed to demonstrate the superiority of this combined treatment.

scholarly journals Esophageal Stent for Refractory Variceal Bleeding: A Systemic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Xiao-Dong Shao ◽  
Xing-Shun Qi ◽  
Xiao-Zhong Guo
Keyword(s):  
Variceal Bleeding ◽  
Meta Analysis ◽  
Esophageal Stent ◽  
Systemic Review ◽  
Cochrane Library ◽  
Metal Stents ◽  
Related Complication ◽  
Stent Deployment ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Background. Preliminary studies suggest that covered self-expandable metal stents may be helpful in controlling esophageal variceal bleeding.Aims. To evaluate the effectiveness and safety of esophageal stent in refractory variceal bleeding in a systematic review and meta-analysis.Methods. A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 1970 to December 2015. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed usingI2test.Results. Five studies involving 80 patients were included in the analysis. The age of patients ranged from 18 to 91 years. The mean duration of follow-up was 46.8 d (range, 30–60 d). The success rate of stent deployment was 96.7% (95% CI: 91.6%–99.5%) and complete response to esophageal stenting was in 93.9% (95% CI: 82.2%–99.6%). The incidence of rebleeding was 13.2% (95% CI: 1.8%–32.8%) and the overall mortality was 34.5% (95% CI: 24.8%–44.8%). Most of patients (87.4%) died from hepatic or multiple organ failure, and only 12.6% of patients died from uncontrolled bleeding. There was no stent-related complication reported and the incidence of stent migration was 21.6% (95% CI: 4.7%–46.1%).Conclusion. Esophageal stent may be considered in patients with variceal bleeding refractory to conventional therapy.

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