Dabas Muath M, Maqbool Muhammad, Bedros Adees W, Mazhar Hiba, Papuashvili Papuna, Umar Muhammad, Bajwa Aqsa B, Patel Dhruvi H, Abushalha Nada B, Khattak Abid, Ahmed Junaid, Mehdi Asma
Surgery, The University of Jordan, Amman, JOR.
Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, PAK.
Cureus. 2024 Oct 22;16(10):e72085. doi: 10.7759/cureus.72085. eCollection 2024 Oct.
Variceal bleeding is a critical complication in cirrhotic patients, significantly increasing morbidity and mortality risks, particularly after an initial bleeding episode. This systematic review evaluates and compares the effectiveness of endoscopic and pharmacological interventions in preventing variceal rebleeding. A comprehensive search of major databases, including PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science, was conducted to identify studies published within the past decade. The review focused on randomized controlled trials, clinical trials, and meta-analyses that assessed the efficacy and safety of these treatments in adult cirrhotic patients with a history of variceal bleeding. The findings suggest that endoscopic interventions, such as band ligation and early transjugular intrahepatic portosystemic shunt (TIPS) placement, effectively reduce immediate rebleeding rates and improve short-term survival, particularly in high-risk patients with advanced cirrhosis. In contrast, pharmacological strategies, including beta-blockers and vasoactive agents, provide effective long-term management with fewer adverse events, especially in patients with milder liver disease. The review underscores the importance of a personalized treatment approach that integrates both endoscopic and pharmacological therapies to optimize outcomes and reduce the burden of rebleeding. It also highlights the need for further high-quality research to clarify the long-term benefits, impact on quality of life, and cost-effectiveness of these interventions. These insights form the basis for refining clinical guidelines and improving patient-centered care in the management of variceal rebleeding.
静脉曲张破裂出血是肝硬化患者的一种严重并发症，显著增加了发病和死亡风险，尤其是在首次出血事件之后。本系统评价评估并比较了内镜和药物干预在预防静脉曲张再出血方面的有效性。对包括PubMed、MEDLINE、Embase、Cochrane对照试验中央登记册和科学网在内的主要数据库进行了全面检索，以识别过去十年内发表的研究。该评价聚焦于评估这些治疗方法对有静脉曲张出血史的成年肝硬化患者疗效和安全性的随机对照试验、临床试验和荟萃分析。研究结果表明，内镜干预，如套扎术和早期经颈静脉肝内门体分流术（TIPS）置入，能有效降低即时再出血率并改善短期生存率，尤其是在晚期肝硬化的高危患者中。相比之下，药物治疗策略，包括β受体阻滞剂和血管活性药物，能提供有效的长期管理，且不良事件较少，特别是在肝病较轻的患者中。该评价强调了采用个性化治疗方法的重要性，这种方法将内镜和药物治疗相结合，以优化治疗效果并减轻再出血负担。它还强调需要进一步开展高质量研究，以阐明这些干预措施的长期益处、对生活质量的影响以及成本效益。这些见解为完善临床指南和改善以患者为中心的静脉曲张再出血管理护理奠定了基础。
