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Zou Z, Yan X, Lu H, et al. Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis. Ann Transl Med. 2019;7(23):717doi: 10.21037/atm.2019.12.26.
Zou, Z., Yan, X., Lu, H., Qi, X., Gu, Y., Li, X., Wu, B., & Qi, X. (2019). Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis. Annals of translational medicine, 7(23), 717. https://doi.org/10.21037/atm.2019.12.26
Zou, Ziyuan, et al. "Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis." Annals of translational medicine vol. 7,23 (2019): 717. doi: https://doi.org/10.21037/atm.2019.12.26
Zou Z, Yan X, Lu H, Qi X, Gu Y, Li X, Wu B, Qi X. Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis. Ann Transl Med. 2019 Dec;7(23):717. doi: 10.21037/atm.2019.12.26. PMID: 32042733; PMCID: PMC6989971.
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Ann Transl Med. 2019 Dec;7(23):717. doi: 10.21037/atm.2019.12.26.

Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis.

Annals of translational medicine

Ziyuan Zou, Xinwen Yan, Huanpeng Lu, Xingshun Qi, Ye Gu, Xun Li, Bin Wu, Xiaolong Qi

Affiliations

  1. CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou 730000, China.
  2. The First School of Clinical Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
  3. Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang 110840, China.
  4. Department of Gastroenterology, The Sixth Peoples Hospital of Shenyang, Shenyang 110003, China.
  5. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.

PMID: 32042733 PMCID: PMC6989971 DOI: 10.21037/atm.2019.12.26

Abstract

BACKGROUND: We aimed to compare the efficacy of different drugs facilitating endoscopy in patients with acute variceal bleeding.

METHODS: Databases were searched to identify randomized controlled trials which compared the efficacy of vasoactive drugs (vasopressin, terlipressin, octreotide, somatostatin) with placebo or each other. The primary outcomes were 6-week and 5-day mortality. Secondary outcomes were 5-day rebleeding, control of initial bleeding and adverse events. Pairwise and network meta-analysis were performed.

RESULTS: We identified 14 RCTs involved 2,187 patients. Four drugs had comparable clinical efficacy in all involving outcomes, except for adverse events. However, we do exhibit a superiority when vasopressin (OR, 4.40; 95% CI: 1.04-19.57), terlipressin (OR, 4.58; 95% CI: 1.63-13.63), octreotide (OR, 5.79; 95% CI: 2.41-16.71) and somatostatin (OR, 5.15; 95% CI: 1.40-27.39) were compared to placebo respectively as for initial hemostasis. In addition, only octreotide was more effective than placebo in decreasing 5-day rebleeding (OR, 0.44; 95% CI: 0.22-0.90). Meanwhile, octreotide was shown to have the highest probability ranking the best to improve initial hemostasis (mean rank =1.8) and carries a lowest risk of adverse events (9.1%) and serious adverse events (0.0%) compared to other drugs.

CONCLUSIONS: Balanced with curative effect and tolerability, octreotide may be the preferred vasoactive drug facilitating endoscopy.

2019 Annals of Translational Medicine. All rights reserved.

Keywords: Cirrhosis; endoscopy; hemorrhage; portal hypertension; vasoconstrictor agents

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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