Outcomes of early versus delayed endoscopy in cirrhotic patients with acute variceal bleeding: A systematic review with meta-analysis

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Bai Z.; Wang R.; Cheng G.; Ma D.; Ibrahim M.; Chawla S.; Qi X.

Journal: European Journal of Gastroenterology and Hepatology

Publisher: Lippincott Williams and Wilkins

Publication Date: 20 September 2021

Volume / Issue: Volume 33 / Issue 1

Pages: E868–E876

ISSN: 0954691X

DOI: 10.1097/MEG.0000000000002282

Scopus: View on Scopus

PubMed: 35048654

Document Type: Article

Authors and Affiliations

Bai Z., Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China; Wang R., Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China; Cheng G., Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China; Ma D., Sixth People's Hospital of Dalian, Dalian, China; Ibrahim M., Theodor Bilharz Research Institute, Cairo, Egypt; Chawla S., Division of Digestive Diseases, Department of Medicine, Emory University, School of Medicine, Atlanta, GA, United States; Qi X., Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China

Abstract

Objectives Endoscopy is the mainstay treatment option for acute variceal bleeding (AVB) in liver cirrhosis. However, the optimal timing of endoscopy in such patients remains unclear. Methods PubMed, EMBASE and Cochrane Library databases were searched. We compared the mortality, incidence of rebleeding, length of stay, endoscopic hemostasis, need for salvage and units of transfusion between cirrhotic patients with AVB who underwent early and delayed endoscopy. Meta-analyses were performed by using a random-effect model. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Subgroup analysis was performed in studies where early endoscopy was defined as <12 h. Results Nine retrospective studies involving 2824 patients were included. The early endoscopy group had a significantly lower overall mortality than the delayed endoscopy group in overall analysis (OR = 0.56, 95% CI, 0.33-0.95, P = 0.03), but the difference between them was NS in subgroup analysis (OR = 0.72, 95% CI, 0.38-1.38, P = 0.33). In-hospital (OR = 0.77, 95% CI, 0.26-2.32, P = 0.65) and 6-week (OR = 0.78, 95% CI, 0.42-1.47, P = 0.45) mortality were not significantly different between them. Overall rebleeding was not significantly different between early and delayed endoscopy groups in both overall (OR = 0.88, 95% CI, 0.51-1.51, P = 0.63) and subgroup (OR = 1.04, 95% CI, 0.55-1.95, P = 0.90) analyses. In-hospital (OR = 1.41, 95% CI, 0.67-2.96, P = 0.37) and 6-week (OR = 0.93, 95% CI, 0.40-2.17, P = 0.86) rebleeding remained not significantly different between them. Additionally, the length of stay, endoscopic hemostasis, need for salvage and units of transfusion were not significantly different between them. Conclusions Early endoscopy may improve the survival of cirrhotic patients with AVB, but has no remarkable benefit on the prevention of rebleeding. These findings should be further validated by high-quality studies. © 2021 Lippincott Williams and Wilkins. All rights reserved.

Keywords

cirrhosis; endoscopy; mortality; rebleeding; variceal bleeding; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Retrospective Studies; adverse event; complication; esophagus varices; gastrointestinal endoscopy; human; meta analysis; retrospective study

Citation Information

Scopus Citations: 49

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