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World Gastroenterology Organisation
World Gastroenterology Organisation
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Treatment of Esophageal Varices

Level: Meta-analyses, Systematic reviews, Practice guidelines: 55 Abstracts

Legend: : Key Development,  : Very Important,  : Important, [no star]: Special Mention


A MELD-based model to determine risk of mortality among patients with acutevariceal bleeding.
Reverter E(1), Tandon P(2), Augustin S(3), Turon F(4), Casu S(4), BastiampillaiR(2), Keough A(2), Llop E(4), González A(3), Seijo S(4), Berzigotti A(4), MaM(2), Genescà J(5), Bosch J(1), García-Pagán JC(1), Abraldes JG(6)., Gastroenterology. 2014 Feb;146(2):412-19.e3. doi: 10.1053/j.gastro.2013.10.018. Epub 2013 Oct 19.

Comments: A MELD-based model accurately predicts mortality among patients with acue variceal bleeding, based on objective variables available at admission.


Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patientswith haemodynamic non-response to propranolol.
Reiberger T(1), Ulbrich G, Ferlitsch A, Payer BA, Schwabl P, Pinter M, HeinischBB, Trauner M, Kramer L, Peck-Radosavljevic M; Vienna Hepatic Hemodynamic Lab., Gut. 2013 Nov;62(11):1634-41. doi: 10.1136/gutjnl-2012-304038. Epub 2012 Dec 18.

Comments: Carvedilol leads to a significantly greater decrease in HVPG than propranolol, and allows to an improved primary prophylaxis even in non-responders to propranolol, associated with improved outcome in the prevention of variceal bleeding, hepatic decompensation and death.


Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis.
Colli A, Gana JC, Turner D, Yap J, Adams-Webber T, Ling SC, Casazza G., Cochrane Database Syst Rev. 2014 Oct 1;10:CD008760. doi: 10.1002/14651858.CD008760.pub2. Review.
Comments: No support for the use of the capsule as a triage test


Effect of recombinant Factor VIIa on outcome of acute variceal bleeding: Anindividual patient based meta-analysis of two controlled trials.
Bendtsen F(1), D'Amico G(2), Rusch E(3), de Franchis R(4), Andersen PK(3), LebrecD(5), Thabut D(6), Bosch J(7)., J Hepatol. 2014 Aug;61(2):252-9. doi: 10.1016/j.jhep.2014.03.035. Epub 2014 Apr 5.

Comments: Meta-analysis showing a beneficial effect of rFVIIa on the primary control of acute variceal bleeding and rebleeding (day 1-5) and 5-day mortality, but with a potential increased risk of arterial thrombo-embolic events.


Liver stiffness is influenced by a standardized meal in patients with chronichepatitis C virus at different stages of fibrotic evolution.
Arena U(1), Lupsor Platon M, Stasi C, Moscarella S, Assarat A, Bedogni G,Piazzolla V, Badea R, Laffi G, Marra F, Mangia A, Pinzani M., Hepatology. 2013 Jul;58(1):65-72. doi: 10.1002/hep.26343. Epub 2013 May 27.

Comments: The present study provides definitive evidence of the confounding effect of a meal on LS measurements for the prediction of fibrosis stage in HCV hepatitis and suggests that a fasting period of 120 min should be observed before the performance of TE.


Transfusion strategies for acute upper gastrointestinal bleeding.
Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C,Graupera I, Poca M, Alvarez-Urturi C, Gordillo J, Guarner-Argente C, Santaló M,Muñiz E, Guarner C., N Engl J Med. 2013 Jan 3;368(1):11-21. doi: 10.1056/NEJMoa1211801.


Characteristics of congenital hepatic fibrosis in a large cohort of patients withautosomal recessive polycystic kidney disease.
Gunay-Aygun M, Font-Montgomery E, Lukose L, Tuchman Gerstein M, Piwnica-Worms K, Choyke P, Daryanani KT, Turkbey B, Fischer R, Bernardini I, Sincan M, Zhao X, Sandler NG, Roque A, Douek DC, Graf J, Huizing M, Bryant JC, Mohan P, Gahl WA, Heller T., Gastroenterology. 2013 Jan;144(1):112-121.e2. doi: 10.1053/j.gastro.2012.09.056. Epub 2012 Oct 3.


Short course adjuvant terlipressin in acute variceal bleeding: a randomizeddouble blind dummy controlled trial.
Azam Z, Hamid S, Jafri W, Salih M, Abbas Z, Abid S, Shah H., J Hepatol. 2012 Apr;56(4):819-24. doi: 10.1016/j.jhep.2011.11.019. Epub 2011 Dec 16.

Comments: Terlipressin (as a bolus of 2 mg followed by 1 mg every 6 h, for the initial 24 h.) is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding, but this study of 130 pts showed that a 24-h course of terlipressin is as effective as a 72-h course when used as an adjunctive therapy to successful EVBL.


American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses.
JH Hwang, SD Rulyak, MB Kimmey, American Gastroenterological Association Institute, Gastroenterology. 2006 Jun:2217-28


Early administration of vapreotide for variceal bleeding in patients with cirrhosis.
P Calès, C Masliah, B Bernard, PP Garnier, C Silvain, N Szostak-Talbodec, JP Bronowicki, D Ribard, D Botta-Fridlund, P Hillon, K Besseghir, D Lebrec, French Club for the Study of Portal Hypertension, N Engl J Med. 2001 Jan 4:23-8


Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis.
C Ripoll, R Groszmann, G Garcia-Tsao, N Grace, A Burroughs, R Planas, A Escorsell, JC Garcia-Pagan, R Makuch, D Patch, DS Matloff, J Bosch, Portal Hypertension Collaborative Group, Gastroenterology. 2007 Aug:481-8


High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: a case-control study.
O Riggio, C Efrati, C Catalano, F Pediconi, O Mecarelli, N Accornero, F Nicolao, S Angeloni, A Masini, L Ridola, AF Attili, M Merli, Hepatology. 2005 Nov:1158-65


Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis.
M Schepke, G Kleber, D Nurnberg, J Willert, L Koch, W Veltzke-Schlieker, C Hellerbrand, J Kuth, S Schanz, S Kahl, WE Fleig, T Sauerbruch, German Study Group for the Primary Prophylaxis of Variceal Bleeding, Hepatology. 2004 Jul:65-72


Management of acute upper gastrointestinal bleeding: summary of NICE guidance.
Dworzynski K, Pollit V, Kelsey A, Higgins B, Palmer K; Guideline Development Group., BMJ. 2012 Jun 13;344:e3412. doi: 10.1136/bmj.e3412.

Comments: Guidelines for the Management of acute upper gastrointestinal bleeding: summary of NICE guidance.


Upper gastrointestinal haemorrhage and deprivation: a nationwide cohort study of health inequality in hospital admissions.
Crooks CJ, West J, Card TR., Gut. 2012 Apr;61(4):514-20. doi: 10.1136/gutjnl-2011-300186. Epub 2011 Jul 13.

Comments: This study demonstrates that people from areas of high socioeconomic deprivation based on seven domains: income deprivation; employment deprivation; health deprivation and disability; education, skills and training deprivation; barriers to housing and services; crime and living environment, have up to three times the rate of upper gi haemorrhage (both variceal and non-variceal) hospitalization compared to people from more affluent areas. If the whole population experienced the same levels of risk as the most affluent, up to 10?000 admissions, costing a total of at least ?20 million, and over 1000 deaths could be prevented each year in England.


Accuracy of Spleen Stiffness Measurement in Detection of Esophageal Varices inPatients With Chronic Liver Disease: Systematic Review and Meta-analysis.
Singh S(1), Eaton JE, Murad MH, Tanaka H, Iijima H, Talwalkar JA., Clin Gastroenterol Hepatol. 2013 Sep 18. pii: S1542-3565(13)01320-7. doi:10.1016/j.cgh.2013.09.013. [Epub ahead of print]

Comments: A meta-analysis of current techniques for measuring spleen stiffness are limited in their accuracy of EV diagnosis.


Measurement of spleen stiffness by acoustic radiation force impulse imagingidentifies cirrhotic patients with esophageal varices.
Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Toshikuni N, Takabatake H,Shimomura H, Doi A, Sakakibara I, Matsueda K, Yamamoto H., Gastroenterology. 2013 Jan;144(1):92-101.e2. doi: 10.1053/j.gastro.2012.09.049. Epub 2012 Sep 27.


A1166C angiotensin II type 1 receptor gene polymorphism may predict hemodynamic response to losartan in patients with cirrhosis and portal hypertension.
S Sookoian, G Castaño, SI García, P Viudez, C González, CJ Pirola, Am J Gastroenterol. 2005 Mar:636-42


ASGE Guideline: the role of endoscopy in the management of variceal hemorrhage, updated July 2005.
W Qureshi, DG Adler, R Davila, J Egan, W Hirota, J Leighton, E Rajan, MJ Zuckerman, R Fanelli, J Wheeler-Harbaugh, TH Baron, DO Faigel, Standards of Practice Committee, Gastrointest Endosc. 2005 Nov:651-5


Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors.
A Mangia, MR Villani, G Cappucci, R Santoro, R Ricciardi, D Facciorusso, G Leandro, N Caruso, A Andriulli, Eur J Gastroenterol Hepatol. 2005 Jul:745-51


Clinical analysis of gastroesophageal reflux after PEG.
S Nishiwaki, H Araki, N Goto, Y Niwa, M Kubota, M Iwashita, N Onogi, H Hatakeyama, T Hayashi, T Maeda, K Saitoh, Gastrointest Endosc. 2006 Dec:890-6


Effects of esophageal varice eradication on portal hypertensive gastropathy and fundal varices: a retrospective and comparative study.
O Yuksel, S K&oeig;klu, M Arhan, OF Yolcu, I Ertu.rul, B Odemi_, E Altiparmak, B Sahin, Dig Dis Sci. 2006 Jan:27-30


Hemodynamics after endoscopic submucosal injection of epinephrine in patients with nonvariceal upper gastrointestinal bleeding: a matter of concern.
S von Delius, P Thies, A Umgelter, C Prinz, RM Schmid, W Huber, Endoscopy. 2006 Dec:1284-8


Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969-2002.
K Stokkeland, L Brandt, A Ekbom, R Hultcrantz, Hepatology. 2006 Mar:500-5


Improved prognosis of cirrhosis patients with esophageal varices and thrombocytopenia treated by endoscopic variceal ligation plus partial splenic embolization.
K Ohmoto, N Yoshioka, Y Tomiyama, N Shibata, M Takesue, K Yoshida, M Kuboki, S Yamamoto, Dig Dis Sci. 2006 Feb:352-8


Is banding ligation for primary prevention of variceal bleeding as effective as beta-blockers, and is it safe?
C Triantos, J Vlachogiannakos, S Manolakopoulos, A Burroughs, A Avgerinos, Hepatology. 2006 Jan:196-7; discussion 197-8


Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis.
F Vizzutti, U Arena, RG Romanelli, L Rega, M Foschi, S Colagrande, A Petrarca, S Moscarella, G Belli, AL Zignego, F Marra, G Laffi, M Pinzani, Hepatology. 2007 May:1290-7


Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis.
Gonzalez R, Zamora J, Gomez-Camarero J, Molinero LM, Bañares R, Albillos A, Ann Intern Med. 2008 Jul 15;149(2):109-22


Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding.
MS Khuroo, NS Khuroo, KL Farahat, YS Khuroo, AA Sofi, ST Dahab, Aliment Pharmacol Ther. 2005 Feb 15:347-61


Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis.
J Turnes, JC Garcia-Pagan, JG Abraldes, M Hernandez-Guerra, A Dell'Era, J Bosch, Am J Gastroenterol. 2006 Mar:506-12


Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters.
SK Sharma, R Aggarwal, J Gastroenterol Hepatol. 2007 Nov:1909-15


Prognostic role of the initial portal pressure gradient reduction after TIPS in patients with cirrhosis.
E Biecker, F Roth, J Heller, HH Schild, T Sauerbruch, M Schepke, Eur J Gastroenterol Hepatol. 2007 Oct:846-52


The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis.
AJ Sanyal, RJ Fontana, AM Di Bisceglie, JE Everhart, MC Doherty, GT Everson, JA Donovan, PF Malet, S Mehta, MY Sheikh, AE Reid, MG Ghany, DR Gretch, Halt-C Trial Group, Gastrointest Endosc. 2006 Dec:855-64


What are the risk factors for aggravation of esophageal varices in patients with hepatocellular carcinoma?
K Kadouchi, K Higuchi, M Shiba, H Okazaki, K Yamamori, E Sasaki, K Tominaga, T Watanabe, Y Fujiwara, N Oshitani, T Arakawa, J Gastroenterol Hepatol. 2007 Feb:240-6


Compliance with practice guidelines and risk of a first esophageal varicealhemorrhage in patients with cirrhosis.
Moodley J, Lopez R, Carey W., Clin Gastroenterol Hepatol. 2010 Aug;8(8):703-8. Epub 2010 Mar 11.


Meta-analysis: isosorbide-mononitrate alone or with either beta-blockers orendoscopic therapy for the management of oesophageal varices.
Gluud LL, Langholz E, Krag A., Aliment Pharmacol Ther. 2010 Oct;32(7):859-71.


Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension.
Y Miyamoto, K Oho, M Kumamoto, A Toyonaga, M Sata, J Gastroenterol Hepatol. 2003 Aug:934-42


Characteristics, prognosis and outcome of patients with oesophageal varices in a university hospital in Sweden 1994-1999.
SA Gunnarsdottir, R Olsson, ES Bj&oeig;rnsson, Scand J Gastroenterol. 2005 Dec:1462-8


Cost-effectiveness analysis of variceal ligation vs. beta-blockers for primary prevention of variceal bleeding.
TF Imperiale, RW Klein, N Chalasani, Hepatology. 2007 Apr:870-8


Endoscopic Doppler US probe for the diagnosis of gastric varices (with videos).
RC Wong, FT Farooq, A Chak, Gastrointest Endosc. 2007 Mar:491-6


Endoscopic therapy for bleeding esophageal varices improves the outcome of Child C cirrhotic patients.
S Hori, A Takaki, H Okada, A Fujiwara, R Takenaka, C Makidono, Y Shiratori, J Gastroenterol Hepatol. 2006 Nov:1704-9


Esophageal capsule endoscopy in patients refusing conventional endoscopy for the study of suspected esophageal pathology.
A Sánchez-Yague, A Caunedo-Alvarez, JM García-Montes, J Romero-Vázquez, FJ Pellicer-Bautista, JM Herrerías-Gutiérrez, Eur J Gastroenterol Hepatol. 2006 Sep:977-83


Esophageal capsule endoscopy versus esophagogastroduodenoscopy for evaluating portal hypertension: a prospective comparative study of performance and tolerance.
MG Lapalus, J Dumortier, F Fumex, S Roman, M Lot, B Prost, F Mion, T Ponchon, Endoscopy. 2006 Jan:36-41


Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension.
G Saracco, C Giordanino, N Roberto, D Ezio, T Luca, S Caronna, P Carucci, W De Bernardi Venon, C Barletti, M Bruno, C De Angelis, A Musso, A Repici, R Suriani, M Rizzetto, Gastrointest Endosc. 2007 Feb:345-7


Pleuropulmonary complications of esophageal variceal sclerotherapy with absolute alcohol.
PK Sethy, R Kochhar, D Behera, DK Bhasin, K Raja, K Singh, J Gastroenterol Hepatol. 2003 Aug:910-4


Prognosis in patients with cirrhosis and mild portal hypertension.
H Ytting, S Møller, JH Henriksen, K Larsen, F Bendtsen, Scand J Gastroenterol. 2006 Dec:1446-53


Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: a national study.
GC Nguyen, DL Segev, PJ Thuluvath, Hepatology. 2007 May:1282-9


Review article: recent advances in the management of bleeding gastric varices.
D Tripathi, JW Ferguson, G Therapondos, JN Plevris, PC Hayes, Aliment Pharmacol Ther. 2006 Jul 1:1-17


Sclerotherapy for gastric fundal variceal bleeding: is complete obliteration possible without cyanoacrylate?
K Kojima, H Imazu, M Matsumura, Y Honda, N Umemoto, H Moriyasu, T Orihashi, M Uejima, C Morioka, Y Komeda, M Uemura, H Yoshiji, H Fukui, J Gastroenterol Hepatol. 2005 Nov:1701-6


The budget impact of endoscopic screening for esophageal varices in cirrhosis.
BM Spiegel, E Esrailian, G Eisen, Gastrointest Endosc. 2007 Oct:679-92


The use of self-expanding metal stents to treat acute esophageal variceal bleeding.
R Hubmann, G Bodlaj, M Czompo, L Benk&oeig;, P Pichler, S Al-Kathib, P Kiblb&oeig;ck, A Shamyieh, G Biesenbach, Endoscopy. 2006 Sep:896-901


The use of transjugular intrahepatic portosystemic stent shunt in the management of acute oesophageal variceal haemorrhage.
NC McAvoy, PC Hayes, Eur J Gastroenterol Hepatol. 2006 Nov:1135-41


Transabdominal gastroesophageal devascularization without transection for bleeding varices: results and indicators of prognosis.
N Goyal, D Singhal, S Gupta, AS Soin, S Nundy, J Gastroenterol Hepatol. 2007 Jan:47-50


Transjugular intrahepatic portosystemic stent-shunt in the management of gastric and ectopic varices.
D Tripathi, R Jalan, Eur J Gastroenterol Hepatol. 2006 Nov:1155-60


Treatment of bleeding gastric varices.
PG Northup, SH Caldwell, J Gastroenterol Hepatol. 2005 Nov:1631-3