Open Access

Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis

  • Authors:
    • Yu Kong
    • Liang Shi
  • View Affiliations

  • Published online on: April 1, 2020     https://doi.org/10.3892/etm.2020.8633
  • Pages: 3479-3496
  • Copyright: © Kong et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The purpose of the present study was to compare the effectiveness of the transjugular intrahepatic portosystemic shunt (TIPS), endoscopic options, medications and mainstay combination therapies for patients with cirrhosis who have had at least one episode of variceal haemorrhage. The PubMed, Embase, Cochrane Library and Web of Science databases, as well as the reference lists of relevant articles, were searched to identify eligible studies. P‑scores, that were based solely on the point estimates and standard errors of the network estimates, were performed to rank all treatments, on a scale from 0 (worst) to 1 (best). The odds ratio (OR) was determined to assess effects on mortality, treatment failure and bleeding from gastroesophageal ulcers. A total of 43 randomized controlled trials comprising 3,787 adult patients were included. In total, 26 (61%) trials adopted concealed randomization, while most studies did not specify blinding. The drug combination of nadolol and isosorbide mononitrate (ISMN) ranked first for lowering risks of overall mortality (P‑score=0.8162), mortality due to liver failure (P‑score=0.7536) and bleeding from gastroesophageal ulcers (P‑score=0.7536). This combination was determined to be superior to endoscopic sclerotherapy (ES) alone (OR=0.63, 95% CI: 0.42‑0.94) and TIPS alone in reducing overall mortality (OR=0.62, 95% CI: 0.40‑0.96). ES was more likely to increase treatment failure compared with TIPS, endoscopic variceal ligation (EVL), ES plus EVL, EVL plus nadolol/propranolol plus ISMN and nadolol/propranolol plus ISMN. In conclusion, the present network meta‑analysis suggested that for a decreased mortality due to variceal rebleeding in patients with cirrhosis, nadolol plus ISMN may be a preferable choice, while ES is associated with a higher risk of unfavourable treatment outcomes. Further well‑controlled studies are required to further elucidate the appropriate treatment options.
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June-2020
Volume 19 Issue 6

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Spandidos Publications style
Kong Y and Kong Y: Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis. Exp Ther Med 19: 3479-3496, 2020
APA
Kong, Y., & Kong, Y. (2020). Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis. Experimental and Therapeutic Medicine, 19, 3479-3496. https://doi.org/10.3892/etm.2020.8633
MLA
Kong, Y., Shi, L."Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis". Experimental and Therapeutic Medicine 19.6 (2020): 3479-3496.
Chicago
Kong, Y., Shi, L."Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta‑analysis". Experimental and Therapeutic Medicine 19, no. 6 (2020): 3479-3496. https://doi.org/10.3892/etm.2020.8633