Suprabhat Giri1 , Saurav Panda2 , Ankita Singh3 , Jijo Varghese4 , Sushrut Ingawale5 , Elliot B Tapper6 , Don C Rockey7 , Ashok Choudhury8 2Department of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, USA
3Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
4Department of Gastroenterology, NS Hospital, Kollam, India
5Division of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine, Bridgeport, USA
6Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA; Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
7Digestive Disease Research Center, Medical University of South Carolina, Charleston, USA
8Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Abstract
Background and Aim: Studies on the duration of vasoconstrictors after endoscopic variceal ligation (EVL) for acute variceal bleeding (AVB) have shown varying results. The present network meta-analysis compared the effectiveness of vasoconstrictors after EVL based on the therapy duration.
Material and Methods: The electronic databases of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched from inception to March 2024 for randomized studies comparing the duration of vasoconstrictors in AVB after EVL (Group 1: ≤ 24 hours, Group 2: >24 to ≤72 hours, Group 3: >72 to ≤120 hours). Rebleeding and mortality risk were analyzed using pair-wise and network meta-analyses.
Results: Eleven studies (n=1,066) met the inclusion criteria. Rebleeding rates varied from 0–38% in Group 1, 2–12% in Group 2, and 0–26% in Group 3. There was no difference in the risk of rebleeding in Group 1 (risk ratio [RR]: 1.36, 95% confidence interval [CI]: 0.48–3.52) or Group 2 (RR: 1.34, 95% CI: 0.42–4.54), compared to Group 3. Similarly, there was no difference either in 5-day mortality risk among the groups (RR: 0.66, 95% CI: 0.09–2.52 and 1.08, 95% CI: 0.15–6.43 for Groups 1 and 2, respectively, vs. Group 3) or 30-day mortality risk (RR: 1.18, 95% CI: 0.51–2.51 and 0.98, 95% CI: 0.36–2.52 for Groups 1 and 2, respectively, vs. Group 3).
Conclusion: The current network meta-analysis provides no evidence to support the use of vasoconstrictors following EVL. These data suggest that vasoconstrictors can be stopped early after EVL, facilitating early discharge from the hospital.
