The Efficacy Of Non-surgical Secondary Prophylaxis Of Esophageal Variceal Bleeding For Cirrhosis: A Multiple-treatments Meta-analysis

Objectives To evaluate the effectiveness of non-surgical secondary prevention measures such as intervention,endoscopy,drugs,and endoscopic combined drugs in the prevention and treatment of esophageal varices(EV)rebleeding in patients with cirrhosis.Evidence supports the choice of secondary prevention and treatment measures for esophageal varices bleeding(EVB).Methods In this study,a reticulated meta-analysis method was used to take the incidence of EV rebleeding,rebleeding-related mortality,and overall mortality as indicators of cirrhosis,by searching Pubmed,Cochrane library,and Embase databases for secondary prevention of EV bleed Randomized controlled trials(RCTs).Two researchers performed a quality evaluation of the literature that met the inclusion criteria and extracted data in accordance with the Cocharane Systematic Review Manual(version 5.0).Meta-analysis was performed using Review Manger(version 5.3)software on the incidence of EV rebleeding,re-bleeding-related mortality,and overall mortality;and STATA(version 15.1)software was used to perform mesh meta-analysis.Results 57 Randomized controlled trials(RCTs)were systematically reviewed,after statistical analysis,it was found that there is a statistically significant difference between EBL + APC and EIS,?-blockers + 5-ISMN,?-blockers in reducing the incidence of EV rebleeding [EBL + APC vs.EIS: OR = 0.12,95% CI:(0.02,0.86;EBL + APC vs.?-blocker + 5-ISMN: OR = 0.09,95% CI:(0.01,0.60);EBL + APC vs.?-blockers: OR = 0.08,95% CI:(0.01,0.67)],TIPS and EBL,EBL + ?-blockers,EIS,?-blockers There is a statistically significant difference between the agents + 5-ISMN,?-blockers [TIPS vs.EBL: OR = 0.32,95% CI:(0.15,0.67);TIPS vs.?-blockers : OR = 0.27,95% CI:(0.13,0.58);TIPS vs.EIS: OR = 0.19,95% CI:(0.09,0.38);TIPS vs.?-blocker + 5-ISMN: OR = 0.13,95% CI:(0.05,0.35);TIPS vs.?-blockers: OR = 0.12,95% CI:(0.04,0.36)].In reducing EV rebleeding related mortality,TIPS And EBL are statistically significant [TIPS vs.EBL: OR = 0.25,95% CI:(0.07,0.92)].There are statistically significant differences between TIPS,EIS,and ?-blockers and placebo significance [TIPS vs.placebo: OR = 0.27,95% CI:(0.08,0.90);EIS vs.placebo: OR = 0.37,95% CI:(0.14,0.97);?-blocker vs.placebo: OR = 0.47,95% CI:(0.23,0.94)].Based on surface under the cumulative ranking curve(SUCRA),In terms of reducing the incidence of rebleeding in EV,endoscopic band ligation(EBL)+ argon plasma coagulation(APC)(91.2%)was superior to transjugular intrahepatic portosystemic shunt(TIPS)(88.7%),endoscopic injection sclerotherapy(EIS)+?-blockers(74.6%),EBL + EIS(70.2%),EBL(53.2%),EBL +?-blockers + 5-ISMN(48.8%),EBL+?-blocker(46.6%),EIS(34.0%),?-blockers + isosorbide-5-mononitrate(5-ISMN)(21.2%),?-blockers(20.7%),placebo(0.9%).In reducing EV rebleeding-related mortality,TIPS(88.5%)was more efficacious than EIS(72.7%),?-blockers(57.1%),EBL + ?-blockers(37.4%),EBL(22.2%),placebo(22.1%).TIPS(82.0%)was superior to EIS + ?-blockers(64.7%),EIS(56.9%),EBL + ?-blockers(55.6%),EBL(43.9%),?-blockers(40.9%),placebo(5.9%)in reducing overall EV mortality.Conclusions 1 Combined with the surface under the cumulative ranking curve,EBL+APC ranks higher in reducing the incidence of EV rebleeding in cirrhosis,indicating that it has more advantages in reducing the incidence of EV rebleeding.2 Combined with the surface under the cumulative ranking curve,TIPS ranked higher in the reduction of EV rebleeding-related mortality and overall mortality in cirrhosis,indicating that TIPS had more advantages in the reduction of EV rebleedingrelated mortality and overall mortality.Figure 11;Table 7;Reference 135...