Predictors and management of post-banding ulcer bleeding in cirrhosis: A systematic review and meta-analysis

被引:7
作者
de Brito Nunes, Maria [1 ,2 ,3 ]
Knecht, Matthias [1 ]
Wiest, Reiner [1 ]
Bosch, Jaume [1 ]
Berzigotti, Annalisa [1 ,4 ]
机构
[1] Univ Bern, Bern Univ Hosp, Dept Visceral Surg & Med, Inselspital, Bern, Switzerland
[2] Hosp Fribourg, Dept Internal Med, Fribourg, Switzerland
[3] Univ Bern, Grad Sch Hlth Sci GHS, Bern, Switzerland
[4] Univ Bern, Univ Clin Visceral Surg & Med, Bern Univ Hosp, Hepatol, MEM F807,Murtenstr 35, CH-3008 Bern, Switzerland
关键词
cirrhosis; oesophageal varices; oesophageal varices endoscopic band ligation; portal hypertension; post-banding ulcer bleeding; ENDOSCOPIC VARICEAL LIGATION; PROTON PUMP INHIBITORS; ESOPHAGEAL-VARICES; BACTERIAL-INFECTIONS; HEMORRHAGE; RISK; ASSOCIATION; GUIDANCE; DISEASE; STENTS;
D O I
10.1111/liv.15621
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and AimsPost-banding ulcer bleeding (PBUB) is an understudied complication of oesophageal varices endoscopic band ligation (EBL). This systematic review with meta-analysis aimed at: (a) evaluating the incidence of PBUB in patients with cirrhosis treated with EBL in primary or secondary prophylaxis or urgent treatment for acute variceal bleeding and (b) identifying predictors of PBUB. MethodsWe conducted a systematic review of articles in English published in 2006-2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were made in eight databases including Embase, PubMed and Cochrane Library. Random-effects meta-analysis was used to determine the incidence, mean interval and predictors of PBUB. ResultsEighteen studies (9034 patients) were included. The incidence of PBUB was 5.5% (95% CI 4.3-7.1). The mean time for it to occur was 11 days (95% CI 9.94-11.97). Model for End-stage Liver Disease (MELD) score (OR 1.162, 95% CI 1.047-1.291) and EBL done in emergency setting (OR 4.902, 95% CI 2.99-8.05) independently predicted post-ligation ulcer bleeding. Treatment included drugs, endoscopic procedures and transjugular intrahepatic portosystemic shunt. Refractory bleeding was treated with self-expandable metallic stents or balloon tamponade. Mortality was on average 22.3% (95% CI 14.1-33.6). ConclusionsPatients with high MELD score and receiving EBL in an emergency setting are more prone to develop PBUB. Prognosis is still poor and the best therapeutic strategy to address remains to be ascertained.
引用
收藏
页码:1644 / 1653
页数:10
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