| Objectives : The method of network meta-analysis was used to analyze and evaluate the therapeutic effect of non-surgical secondary prevention of esophageal variceal bleeding(EVB)in patients with liver cirrhosis,namely the prevention of rebleeding.Primary prevention treatment provides a theoretical basis.Methods : Search the English literature of randomized controlled trials on non-surgical secondary prevention of EVB in patients with liver cirrhosis published up to March 2022 in databases such as Web of science,Embase,Pubmed,and the Cochrane Library,and complete literature screening and quality assessment.Afterwards,stata software was used to complete network meta-analysis,sensitivity analysis,and publication bias identification.The main outcomes included mortality and rebleeding.The analysis results were expressed using 95% confidence intervals and odds ratios.Results:A total of 42 articles were finally included in this study,and a total of 4203 patients with untreated portal hypertension due to cirrhosis who had a recent history of variceal bleeding were included in this study.Through NMA,transjugular intrahepatic porto systemic shunt(TIPS)(SUCRA,98.2%)showed significant advantages over all other treatments in reducing rebleeding;Endoscopic variceal ligation(EVL)+NSBB(isosorbide mononitrate(ISMN))compared with nonselective beta-blockers(NSBB)monotherapy(OR: 0.38;CI :0.22-0.79)、EVL(OR:0.54;CI: 0.27-0.98),endoscopic injection sclerotherapy(EIS)+NSBB(OR: 0.45;CI: 0.20-0.94)and NSB+ISMN(OR: 0.49;CI: 0.28-0.93).Carvedilol(CDL)had the highest overall survival rate(SUCRA,85.6%);CDL(OR: 0.32;CI: 0.16-0.95)and EIS+NSBB(OR: 0.41;CI: 0.21-0.96)had a certain advantage in reducing mortality;And EIS+NSBB(OR: 1.81;CI: 1.05-3.98);Compared with EVL,CDL has a higher survival advantage(OR: 0.46;CI:0.18-0.95).Conclusions : Among the non-surgical preventive measures for variceal rebleeding in cirrhosis,CDL has a good effect in improving survival rate,and TIPS has more advantages in reducing rebleeding. |
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