Which secondary prophylaxis is best at reducing EV bleeding, mortality in cirrhotics?

Transjugular intrahepatic portosystemic shunt (TIPS) is superior to endoscopic band ligation (EBL) and other nonsurgical secondary prophylaxis interventions in reducing the incidence of cirrhosis oesophageal varices (EV) rebleeding, rebleeding-related mortality, and overall mortality in cirrhosis, results of a study have shown.

The investigators searched for secondary prophylaxis of EV rebleeding in cirrhosis on PubMed, Embase, and the Cochrane Library databases. Two independent reviewers assessed the quality of studies based on the requirements of Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.0.

Meta-analysis was conducted on Review Manager 5.3 software for the incidence of cirrhosis EV rebleeding, rebleeding-related mortality, and overall mortality. For network meta-analysis, STATA 5.1 software was used.

Fifty-five randomized controlled trials met the eligibility criteria. Guidelines did not recommend EBL+argon plasma coagulation, which was rarely used.

TIPS (surface under the cumulative ranking curve [SUCRA], 94.3 percent) was more effective at reducing the incidence of rebleeding than EBL+endoscopic injection sclerotherapy (EIS; 84.4 percent), EIS+β-blockers (77.9 percent), EBL (59.8 percent), EBL+β-blockers+isosorbide-5-mononitrate (52.7 percent), EBL+β-blockers (51.4 percent), EIS (34.2 percent), β-blockers+isosorbide-5-mononitrate (23.7 percent), β-blockers (20.8 percent), and placebo (0.8 percent).

In reducing rebleeding-related mortality, TIPS (SUCRA, 87.2 percent) was superior to EBL+EIS (83.5 percent), EIS (47.9 percent), EBL+β-blockers (47.4 percent), β-blockers (41.8 percent), EBL (34.5 percent), and placebo (7.6 percent). TIPS (SUCRA, 81.1 percent) was also more effective in reducing overall mortality than EBL+EIS (68.9 percent), EIS+β-blockers (59.2 percent), EBL+β-blockers (55.4 percent), EIS (48.8 percent), EBL (48.7 percent), β-blockers (34.2 percent), and placebo (3.6 percent).

“Combined with the above results, TIPS is more likely to be recommended as a secondary prophylaxis intervention for EV in cirrhosis,” the investigators said.