Secondary Prophylaxis of Gastric Variceal Bleeding: A Systematic Review and Network Meta‐Analysis

医学 荟萃分析 相对风险 置信区间 随机对照试验 内科学 硬化疗法 肝硬化 外科 系统回顾 梅德林 政治学 法学
作者
Karim Osman,Tarek Nayfeh,Ahmed Abdelfattah,Khaled Alabdallah,Bashar Hasan,Mohammed Firwana,Homam Alabaji,Lina Elkhabiry,Jehan Mousa,Larry J. Prokop,Mohammad Hassan Murad,Fredric D. Gordon
出处
期刊:Liver Transplantation [Wiley]
卷期号:28 (6): 945-958 被引量:7
标识
DOI:10.1002/lt.26383
摘要

There is no clear consensus regarding the optimal approach for secondary prophylaxis of gastric variceal bleeding (GVB) in patients with cirrhosis. We conducted a systematic review and network meta-analysis (NMA) to compare the efficacy of available treatments. A comprehensive search of several databases from each database's inception to March 23, 2021, was conducted to identify relevant randomized controlled trials (RCTs). Outcomes of interest were rebleeding and mortality. Results were expressed as relative risk (RR) and 95% confidence interval (CI). We followed the Grading of Recommendations Assessment, Development, and Evaluation approach to rate the certainty of evidence. We included 9 RCTs with 647 patients who had histories of GVB and follow-ups >6 weeks. A total of 9 interventions were included in the NMA. Balloon-occluded retrograde transvenous obliteration (BRTO) was associated with a lower risk of rebleeding when compared with β-blockers (RR, 0.04; 95% CI, 0.01-0.26; low certainty), and endoscopic injection sclerotherapy (EIS)–cyanoacrylate (CYA) (RR, 0.18; 95% CI, 0.04-0.77; low certainty). β-blockers were associated with a higher risk of rebleeding compared with most interventions and with increased mortality compared with EIS-CYA (RR, 4.12, 95% CI, 1.50-11.36; low certainty), and EIS-CYA + nonselective β-blockers (RR, 5.61; 95% CI, 1.91-16.43; low certainty). Analysis based on indirect comparisons suggests that BRTO may be the best intervention in preventing rebleeding, whereas β-blocker monotherapy is likely the worst in preventing rebleeding and mortality. Head-to-head RCTs are needed to validate these results.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
WTH完成签到,获得积分10
3秒前
无脚鸟完成签到,获得积分10
4秒前
YDSG完成签到,获得积分10
7秒前
7秒前
阿宝完成签到 ,获得积分10
7秒前
现代的烤鸡完成签到,获得积分10
8秒前
被动科研完成签到,获得积分10
8秒前
cccyyb应助Wang采纳,获得10
9秒前
blusky完成签到,获得积分10
9秒前
xiang完成签到,获得积分10
10秒前
棵虫完成签到,获得积分10
10秒前
zzz完成签到,获得积分10
11秒前
欢喜念双发布了新的文献求助30
11秒前
领导范儿应助苦西迪采纳,获得10
11秒前
11秒前
殷勤的咖啡完成签到,获得积分10
11秒前
12秒前
blusky发布了新的文献求助10
13秒前
why完成签到,获得积分10
15秒前
111111完成签到,获得积分10
15秒前
贵贵完成签到,获得积分10
17秒前
m30完成签到,获得积分10
18秒前
cannon8发布了新的文献求助10
19秒前
19秒前
稳重岩完成签到 ,获得积分10
20秒前
星海完成签到,获得积分10
21秒前
sky998524完成签到,获得积分10
22秒前
22秒前
弧光完成签到 ,获得积分10
22秒前
肖窈应助EVAN采纳,获得10
26秒前
miaomiao发布了新的文献求助10
28秒前
本来就这样完成签到,获得积分10
28秒前
科目三应助如初采纳,获得10
30秒前
科目三应助Jim luo采纳,获得10
30秒前
31秒前
FashionBoy应助guantlv采纳,获得10
31秒前
小吕完成签到,获得积分10
32秒前
神圣先知完成签到,获得积分10
33秒前
briliian完成签到,获得积分10
33秒前
没有逗应助scm采纳,获得10
33秒前
高分求助中
Sustainability in Tides Chemistry 1500
Handbook of the Mammals of the World – Volume 3: Primates 805
拟南芥模式识别受体参与调控抗病蛋白介导的ETI免疫反应的机制研究 550
Gerard de Lairesse : an artist between stage and studio 500
Digging and Dealing in Eighteenth-Century Rome 500
Queer Politics in Times of New Authoritarianisms: Popular Culture in South Asia 500
Manual of Sewer Condition Classification 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3068382
求助须知:如何正确求助?哪些是违规求助? 2722240
关于积分的说明 7476489
捐赠科研通 2369329
什么是DOI,文献DOI怎么找? 1256334
科研通“疑难数据库(出版商)”最低求助积分说明 609550
版权声明 596835