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. 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

Ziyuan Zou  1   2 , Xinwen Yan  1   2 , Huanpeng Lu  2 , Xingshun Qi  3 , Ye Gu  4 , Xun Li  1 , Bin Wu  5 , Xiaolong Qi  1
Affiliations

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

Ziyuan Zou et al. Ann Transl Med. 2019 Dec.

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.

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

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
Study selection.
Figure 2
Figure 2
Network geometry of trials for six-week mortality (A), five-day mortality (B), rebleeding (C) and control of initial bleeding (D).
Figure 3
Figure 3
Direct meta-analysis for six-week mortality (A), five-day mortality (B), rebleeding (C) and control of initial bleeding (D).
Figure S1
Figure S1
Quality assessment of included studies.
Figure S2
Figure S2
Funnel plots of 6-week mortality (A), five-day mortality (B), rebleeding (C) and control of initial bleeding (D).
See this image and copyright information in PMC

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