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.

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 Necessity of vasoconstrictors for esophageal variceal bleeding after endoscopic ligation: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Jen-Hao Yeh ◽  
Gin Lo ◽  
Ru-Yi Huang ◽  
Chih-Wen Lin ◽  
Wen-Lun Wang
Keyword(s):  
Treatment Failure ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Current Evidence ◽  
Cochrane Library ◽  
Combination Regimen ◽  
Endoscopic Variceal Ligation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Abstract BackgroundSeveral recent trials have suggested that the need for vasoconstrictors for preventing esophageal variceal bleeding may be considerably reduced after endoscopic variceal ligation (EVL). However, comprehensive systematic reviews on this topic are hardly available. MethodsA meticulous literature review and meta-analysis were conducted using the databases of PubMed, Embase, and the Cochrane Library. Primary outcomes were initial hemostasis, rebleeding, mortality, and treatment failure within 5 days, and secondary outcomes were 6-week mortality and adverse events. ResultsFive randomized trials with 423 participants were included in the meta-analysis. The results revealed that the following outcomes were similar in groups that received only EVL and a standard combination regimen: initial hemostasis (97.6% vs. 98.0%, risk ratio (RR) = 1.00, 95% confidence interval (CI) = 0.97–1.02), 5-day rebleeding (15.9% vs. 6.6%, RR = 2.25, 95% CI = 0.87–5.77), treatment failure (9.6% vs. 6.7%, RR = 1.43, 95% CI = 0.54––3.75), 5-day mortality rates (0 vs. 0.7%, RR = 0.81, 95% CI = 0.09–6.87), and 6-week mortality rates (2.9% vs. 3.0%, RR = 0.88, 95% CI = 0.25–3.13). By contrast, sensitivity analysis suggested obvious clinical heterogeneity in 5-day rebleeding although an outlier study was identified. ConclusionIn patients with acute esophageal variceal bleeding after EVL, 5-day and 6-week mortality rates were similar regardless of vasoconstrictor use. However, considering the controversial 5-day rebleeding rate, short course of vasoconstrictor use based on current evidence may be reasonable.

Self-expandable metal stents as definitive treatment for esophageal variceal bleeding

Endoscopy ◽  
2013 ◽  
Vol 45 (06) ◽  
pp. 485-488 ◽  
Author(s):  
I. Holster ◽  
E. Kuipers ◽  
H. van Buuren ◽  
M. Spaander ◽  
E. Tjwa
Keyword(s):  
Variceal Bleeding ◽  
Definitive Treatment ◽  
Metal Stents ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

scholarly journals Self-Expandable Metal Stents in the Treatment of Acute Esophageal Variceal Bleeding

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Àngels Escorsell ◽  
Jaime Bosch
Keyword(s):  
Variceal Bleeding ◽  
Endoscopic Therapy ◽  
Massive Bleeding ◽  
Metal Stents ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
New Device ◽  
Balloon Tamponade ◽  
Banding Ligation ◽  
Temporary Control

Acute variceal bleeding (AVB) is a life-threatening complication in patients with cirrhosis. Hemostatic therapy of AVB includes early administration of vasoactive drugs that should be combined with endoscopic therapy, preferably banding ligation. However, failure to control bleeding or early rebleed within 5 days still occurs in 15–20% of patients with AVB. In these cases, a second endoscopic therapy may be attempted (mild bleeding in a hemodynamically stable patient) or we can use a balloon tamponade as a bridge to definitive derivative treatment (i.e., a transjugular intrahepatic portosystemic shunt). Esophageal balloon tamponade provides initial control in up to 80% of AVB, but it carries a high risk of major complications, especially in cases of long duration of tamponade (>24 h) and when tubes are inserted by inexperienced staff. Preliminary reports suggest that self-expandable covered esophageal metallic stents effectively control refractory AVB (i.e., ongoing bleeding despite pharmacological and endoscopic therapy or massive bleeding precluding endoscopic therapy) with a low incidence of complications. Thus, covered self-expanding metal stents may represent an alternative to the Sengstaken-Blakemore balloon for the temporary control of bleeding in treatment failures. Further studies are required to determine the role of this new device in AVB.

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