Capital Medical University School of Nursing.
Department of Gastroenterology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei Province.
J Clin Gastroenterol. 2021 Feb 1;55(2):159-168. doi: 10.1097/MCG.0000000000001436.
The aim of this study was to evaluate the effectiveness of nonsurgical secondary prophylaxis interventions for esophageal varices (EV) rebleeding in cirrhotic patients using network meta-analysis.
Secondary prophylaxis of EV rebleeding in cirrhosis is searched on PubMed, Embase, and the Cochrane Library databases. The quality of literatures was extracted by 2 independent investigators according to the requirements of Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.0. Meta-analysis was performed on Review Manager 5.3 software for the incidence of cirrhosis EV rebleeding, rebleeding-related mortality, and overall mortality; and STATA 15.1 software was used for network meta-analysis.
In all, 57 randomized controlled trials were reviewed. Endoscopic band ligation (EBL)+argon plasma coagulation has not been recommended by guidelines, and it is rarely used; the number of existing studies and the sample size are small. Considering poor stability of the combined results, these studies were excluded; 55 literatures were included. In terms of reducing the incidence of rebleeding, transjugular intrahepatic portosystemic shunt (TIPS) surface under the cumulative ranking curve (SUCRA) (94.3%) was superior to EBL+endoscopic injection sclerotherapy (EIS) (84.4%), EIS+β-blockers (77.9%), EBL (59.8%), EBL+β-blockers+isosorbide-5-mononitrate (52.7%), EBL+β-blockers (51.4%), EIS (34.2%), β-blockers+isosorbide-5-mononitrate (23.7%), β-blockers (20.8%), and placebo (0.8%). In reducing rebleeding-related mortality, TIPS SUCRA (87.2%) was more efficacious than EBL+EIS (83.5%), EIS (47.9%), EBL+β-blockers (47.4%), β-blockers (41.8%), EBL (34.5%), and placebo (7.6%). In reducing overall mortality, TIPS SUCRA (81.1%) was superior to EBL+EIS (68.9%), EIS+β-blockers (59.2%), EBL+β-blockers (55.4%), EIS (48.8%), EBL (48.7%), β-blockers (34.2%), placebo (3.6%).
TIPS was more effective in reducing the incidence of cirrhosis EV rebleeding, rebleeding-related mortality, and overall mortality in cirrhosis. Combined with the above results, TIPS is more likely to be recommended as a secondary prophylaxis intervention for EV in cirrhosis.
本研究旨在通过网络荟萃分析评估非手术性食管静脉曲张（EV）再出血二级预防干预措施在肝硬化患者中的疗效。
在 PubMed、Embase 和 Cochrane 图书馆数据库中检索肝硬化 EV 再出血的二级预防。根据 Cochrane 系统评价干预手册 5.0.0 的要求，由 2 名独立研究者提取文献质量。采用 Review Manager 5.3 软件对肝硬化 EV 再出血、再出血相关死亡率和总死亡率的发生率进行荟萃分析；采用 STATA 15.1 软件进行网络荟萃分析。
共纳入 57 项随机对照试验。内镜套扎（EBL）+氩等离子凝固术（APC）未被指南推荐，且应用较少；现有研究数量和样本量较小。考虑到联合结果的稳定性较差，这些研究被排除在外；纳入 55 篇文献。在降低再出血发生率方面，经颈静脉肝内门体分流术（TIPS）累积排序曲线下面积（SUCRA）（94.3%）优于 EBL+内镜注射硬化疗法（EIS）（84.4%）、EIS+β受体阻滞剂（77.9%）、EBL（59.8%）、EBL+β受体阻滞剂+单硝酸异山梨酯（52.7%）、EBL+β受体阻滞剂（51.4%）、EIS（34.2%）、β受体阻滞剂+单硝酸异山梨酯（23.7%）、β受体阻滞剂（20.8%）和安慰剂（0.8%）。在降低再出血相关死亡率方面，TIPS SUCRA（87.2%）优于 EBL+EIS（83.5%）、EIS（47.9%）、EBL+β受体阻滞剂（47.4%）、β受体阻滞剂（41.8%）、EBL（34.5%）和安慰剂（7.6%）。在降低总死亡率方面，TIPS SUCRA（81.1%）优于 EBL+EIS（68.9%）、EIS+β受体阻滞剂（59.2%）、EBL+β受体阻滞剂（55.4%）、EIS（48.8%）、EBL（48.7%）、β受体阻滞剂（34.2%）和安慰剂（3.6%）。
TIPS 可更有效地降低肝硬化 EV 再出血、再出血相关死亡率和总死亡率。结合以上结果，TIPS 更有可能被推荐为肝硬化 EV 的二级预防干预措施。
