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

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

doi:10.1002/14651858.cd013155.pub2

Abstract

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

Highlights

Liver cirrhosis The liver is a complex organ with multiple functions including carbohydrate metabolism, fat metabolism, protein metabolism, drug metabolism, synthetic functions, storage functions, digestive functions, excretory functions, and immunological functions (Read 1972)
The global prevalence of liver cirrhosis is difficult to estimate as most estimates correspond to chronic liver disease
With this systematic review and network meta-analysis, we aim to provide the best level of evidence for the benefits and harms of different treatments for acute bleeding oesophageal varices due to liver cirrhosis

Summary

BACKGROUND

Liver cirrhosis The liver is a complex organ with multiple functions including carbohydrate metabolism, fat metabolism, protein metabolism, drug metabolism, synthetic functions, storage functions, digestive functions, excretory functions, and immunological functions (Read 1972). The major cause of complications and deaths in people with liver cirrhosis is due to the development of clinically significant portal hypertension (hepatic venous pressure gradient at least 10 mmHg) (de Franchis 2015). Other risk factors for bleeding from oesophageal varices include the pressure within the varices (hepatic venous pressure gradient at least 12 mmHg), increased tension on the variceal wall as indicated by red spots or red wale markings (longitudinal red streaks on the varices) on endoscopy, and severity of the liver disease (Beppu 1981; NIEC 1988; de Franchis 2015; Tripathi 2015). The two major classes of drugs that have been used in the control of acute variceal bleeding include vasoconstrictors such as vasopressin or terlipressin; and somatostatin or its analogue octreotide (de Franchis 2015; Tripathi 2015; Garcia-Tsao 2017; EASL 2018). We will present results from direct comparisons whenever possible, even if we perform the network meta-analysis

OBJECTIVES

METHODS

Findings

Methods for indirect and mixed comparisons