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• W2891873205 abstract "Approximately 40% to 95% of people with cirrhosis have oesophageal varices. About 15% to 20% of oesophageal varices bleed in about one to three years of diagnosis. Several different treatments are available, which include endoscopic sclerotherapy, variceal band ligation, beta-blockers, transjugular intrahepatic portosystemic shunt (TIPS), and surgical portocaval shunts, among others. However, there is uncertainty surrounding their individual and relative benefits and harms.To compare the benefits and harms of different initial treatments for secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis through a network meta-analysis and to generate rankings of the different treatments for secondary prevention according to their safety and efficacy.We searched CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and trials registers until December 2019 to identify randomised clinical trials in people with cirrhosis and a previous history of bleeding from oesophageal varices.We included only randomised clinical trials (irrespective of language, blinding, or status) in adults with cirrhosis and previous history of bleeding from oesophageal varices. We excluded randomised clinical trials in which participants had no previous history of bleeding from oesophageal varices, previous history of bleeding only from gastric varices, those who failed previous treatment (refractory bleeding), those who had acute bleeding at the time of treatment, and those who had previously undergone liver transplantation.We performed a network meta-analysis with OpenBUGS using Bayesian methods and calculated the differences in treatments using hazard ratios (HR), odds ratios (OR) and rate ratios with 95% credible intervals (CrI) based on an available-case analysis, according to National Institute of Health and Care Excellence Decision Support Unit guidance.We included a total of 48 randomised clinical trials (3526 participants) in the review. Forty-six trials (3442 participants) were included in one or more comparisons. The trials that provided the information included people with cirrhosis due to varied aetiologies. The follow-up ranged from two months to 61 months. All the trials were at high risk of bias. A total of 12 interventions were compared in these trials (sclerotherapy, beta-blockers, variceal band ligation, beta-blockers plus sclerotherapy, no active intervention, TIPS (transjugular intrahepatic portosystemic shunt), beta-blockers plus nitrates, portocaval shunt, sclerotherapy plus variceal band ligation, beta-blockers plus nitrates plus variceal band ligation, beta-blockers plus variceal band ligation, sclerotherapy plus nitrates). Overall, 22.5% of the trial participants who received the reference treatment (chosen because this was the commonest treatment compared in the trials) of sclerotherapy died during the follow-up period ranging from two months to 61 months. There was considerable uncertainty in the effects of interventions on mortality. Accordingly, none of the interventions showed superiority over another. None of the trials reported health-related quality of life. Based on low-certainty evidence, variceal band ligation may result in fewer serious adverse events (number of people) than sclerotherapy (OR 0.19; 95% CrI 0.06 to 0.54; 1 trial; 100 participants). Based on low or very low-certainty evidence, the adverse events (number of participants) and adverse events (number of events) may be different across many comparisons; however, these differences are due to very small trials at high risk of bias showing large differences in some comparisons leading to many differences despite absence of direct evidence. Based on low-certainty evidence, TIPS may result in large decrease in symptomatic rebleed than variceal band ligation (HR 0.12; 95% CrI 0.03 to 0.41; 1 trial; 58 participants). Based on moderate-certainty evidence, any variceal rebleed was probably lower in sclerotherapy than in no active intervention (HR 0.62; 95% CrI 0.35 to 0.99, direct comparison HR 0.66; 95% CrI 0.11 to 3.13; 3 trials; 296 participants), beta-blockers plus sclerotherapy than sclerotherapy alone (HR 0.60; 95% CrI 0.37 to 0.95; direct comparison HR 0.50; 95% CrI 0.07 to 2.96; 4 trials; 231 participants); TIPS than sclerotherapy (HR 0.18; 95% CrI 0.08 to 0.38; direct comparison HR 0.22; 95% CrI 0.01 to 7.51; 2 trials; 109 participants), and in portocaval shunt than sclerotherapy (HR 0.21; 95% CrI 0.05 to 0.77; no direct comparison) groups. Based on low-certainty evidence, beta-blockers alone and TIPS might result in more, other compensation, events than sclerotherapy (rate ratio 2.37; 95% CrI 1.35 to 4.67; 1 trial; 65 participants and rate ratio 2.30; 95% CrI 1.20 to 4.65; 2 trials; 109 participants; low-certainty evidence). The evidence indicates considerable uncertainty about the effect of the interventions including those related to beta-blockers plus variceal band ligation in the remaining comparisons.The evidence indicates considerable uncertainty about the effect of the interventions on mortality. Variceal band ligation might result in fewer serious adverse events than sclerotherapy. TIPS might result in a large decrease in symptomatic rebleed than variceal band ligation. Sclerotherapy probably results in fewer 'any' variceal rebleeding than no active intervention. Beta-blockers plus sclerotherapy and TIPS probably result in fewer 'any' variceal rebleeding than sclerotherapy. Beta-blockers alone and TIPS might result in more other compensation events than sclerotherapy. The evidence indicates considerable uncertainty about the effect of the interventions in the remaining comparisons. Accordingly, high-quality randomised comparative clinical trials are needed." @default.
• W2891873205 created "2018-09-27" @default.
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• W2891873205 date "2021-03-30" @default.
• W2891873205 modified "2023-09-26" @default.
• W2891873205 title "Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis" @default.
• W2891873205 cites W1481953990 @default.
• W2891873205 cites W1482298482 @default.
• W2891873205 cites W1493060657 @default.
• W2891873205 cites W1495203552 @default.
• W2891873205 cites W1507700591 @default.
• W2891873205 cites W1517026436 @default.
• W2891873205 cites W1517710152 @default.
• W2891873205 cites W1524679074 @default.
• W2891873205 cites W1531620113 @default.
• W2891873205 cites W1534719948 @default.
• W2891873205 cites W1540337819 @default.
• W2891873205 cites W1546359130 @default.
• W2891873205 cites W1552630832 @default.
• W2891873205 cites W1593043915 @default.
• W2891873205 cites W1601779159 @default.
• W2891873205 cites W1607477581 @default.
• W2891873205 cites W1617328014 @default.
• W2891873205 cites W1641040312 @default.
• W2891873205 cites W1658922016 @default.
• W2891873205 cites W1677778680 @default.
• W2891873205 cites W170226017 @default.
• W2891873205 cites W172107136 @default.
• W2891873205 cites W1770014952 @default.
• W2891873205 cites W1789259168 @default.
• W2891873205 cites W1802161541 @default.
• W2891873205 cites W184308473 @default.
• W2891873205 cites W1878686177 @default.
• W2891873205 cites W1886146436 @default.
• W2891873205 cites W1899099619 @default.
• W2891873205 cites W191145378 @default.
• W2891873205 cites W1937469442 @default.
• W2891873205 cites W1957005022 @default.
• W2891873205 cites W1964489041 @default.
• W2891873205 cites W1964502734 @default.
• W2891873205 cites W1964620019 @default.
• W2891873205 cites W1964963325 @default.
• W2891873205 cites W1966464807 @default.
• W2891873205 cites W1967218527 @default.
• W2891873205 cites W1967365291 @default.
• W2891873205 cites W1967416592 @default.
• W2891873205 cites W1967484100 @default.
• W2891873205 cites W1967498166 @default.
• W2891873205 cites W1967522559 @default.
• W2891873205 cites W1968432206 @default.
• W2891873205 cites W1969175631 @default.
• W2891873205 cites W1969596583 @default.
• W2891873205 cites W1970752949 @default.
• W2891873205 cites W1971895240 @default.
• W2891873205 cites W1972019808 @default.
• W2891873205 cites W1972504268 @default.
• W2891873205 cites W1973164007 @default.
• W2891873205 cites W1974242482 @default.
• W2891873205 cites W1975087580 @default.
• W2891873205 cites W1975598811 @default.
• W2891873205 cites W1975776831 @default.
• W2891873205 cites W1976442249 @default.
• W2891873205 cites W1977498555 @default.
• W2891873205 cites W1977641848 @default.
• W2891873205 cites W1978055496 @default.
• W2891873205 cites W1980402421 @default.
• W2891873205 cites W1980734258 @default.
• W2891873205 cites W1980938177 @default.
• W2891873205 cites W1983158738 @default.
• W2891873205 cites W1983564602 @default.
• W2891873205 cites W1985612238 @default.
• W2891873205 cites W1986423100 @default.
• W2891873205 cites W1986472764 @default.
• W2891873205 cites W1987305426 @default.
• W2891873205 cites W1987446916 @default.
• W2891873205 cites W1987530799 @default.
• W2891873205 cites W1989876346 @default.
• W2891873205 cites W1990094116 @default.
• W2891873205 cites W1990239682 @default.
• W2891873205 cites W1991391866 @default.
• W2891873205 cites W1992250826 @default.

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