*EMBARGOED All research presented at the 2021 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Sunday, October 24, 2021, at 3:30 pm EDT.
Oral 5 Secondary Prophylaxis of Gastric Variceal Bleeding: A Systematic Review and Network Meta-Analysis
Author Insight from Karim T. Osman, MD, Lahey Hospital and Medical Center
What’s new here and important for clinicians?
The prevention of gastric variceal bleeding (GVB) is a critical effort in the management of patients with portal hypertension and spans multiple disciplines, but the optimal approach is not well-defined in the literature. Randomized trials are lacking.
This is the first network metanalysis that compares the two predominant interventions in this secondary prophylaxis of gastric varices: BRTO and endoscopic injection sclerotherapy, as well as other interventions.
BRTO outperformed injection sclerotherapy in the prevention of re-bleeding.
Beta-blocker monotherapy demonstrated the lowest likelihood of preventing rebleeding or mortality.
These findings provide a rubric to address the challenges in clinical decision making around GVB secondary prophylaxis and should encourage a multidisciplinary discussion between interventional radiology and gastroenterology specialists in the co-management of GVB based on provider-specific expertise.
What do patients need to know?
Varices are enlarged veins that form from high pressures in the veins that drain into the liver, which can be associated with many medical conditions, most commonly chronic liver disease. Varices can occur anywhere along the gastrointestinal tract.
While gastric (stomach) varices are less common than esophageal varices, they present considerable management challenges for medical teams and are associated with higher rates of death and rebleeding. Understanding the ideal approach to addressing gastric varices achieving effective secondary prophylaxis is vital
At this time, there is no clear consensus regarding the optimal approach for to prevent gastric variceal bleeding.
Typically, a common approach to gastric varices has been to prescribe a medication called a “beta blocker” to lower pressure in the vein system that drains the liver. However, our study showed that this approach was associated with higher rates of re-bleeding compared to other interventions. These interventions included obliteration of the enlarged blood vessel through an interventional radiology procedure (BRTO) or injection of a compound into the vessel through an endoscopy.
Karim T. Osman, MD, Lahey Hospital and Medical Center
ktarek [dot] osman [at] gmail [dot] com
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