BRTO ranks ‘high’ as best intervention for secondary prophylaxis of GI bleeds
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LAS VEGAS – Balloon-occluded retrograde transvenous obliteration ranked highest as best intervention for gastrointestinal bleeding among other secondary prophylaxis treatments, according to a presenter at the ACG Scientific Annual Meeting.
“Beta-blocker monotherapy might not be an appropriate measure for secondary prophylaxis of gastric varices, and this is not completely surprising given that we tend to not use it in secondary prophylaxis of esophageal varices either as a monotherapy,” Karim T. Osman, MD, from the Lahey Hospital and Medical Center in Burlington, Massachusetts, said during the presentation. “But it did provide better rebleeding outcomes compared to endoscopic hypertonic glucose injection.”
Osman and colleagues performed a network meta-analysis to compare benefits of treatments for the secondary prophylaxis of gastric variceal bleeding in patients with cirrhosis. They identified nine randomized controlled trials that included 673 patients with gastric variceal bleeding who underwent treatment for secondary prophylaxis. The interventions included were beta-blocker, balloon-occluded retrograde transvenous obliteration (BRTO), endoscopic injection sclerotherapy with cyanoacrylate (EIS-CYA) or hypertonic glucose (Glu) or alcohol (EtOH), endoscopic variceal ligation (EVL), endoscopic ultrasound-guided sclerotherapy with cyanoacrylate (EUS-CYA) and transjugular intrahepatic portosystemic shunt (TIPS).
Researchers ranked the treatments from best to worst using P values. The strength of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus were used as data sources.
Osman and colleagues found BRTO compared with the beta-blocker (RR = 0.04; 95% CI, 0.01-0.26), EIS-CYA (RR = 0.18; 95% CI, 0.04-0.77) and combination of EIS-CYA and EVL (RR = 0.07; 95% CI, 0.01-0.4) had a lower risk for rebleeding. Compared with BRTO, EIS-CYA, EUS-CYA, and TIPS, beta-blocker had a higher risk for rebleeding.
According to researchers, the highest-ranking interventions were EUS-CYA (P = 0.9) and BRTO (P = .84). Beta-blocker ranked the lowest with regard to rebleeding (RR = 4.85; 95% CI, 1.04-22.67, low strength of evidence). Increased mortality was noted in beta-blocker compared with EIS-CYA (RR = 4.85; 95% CI, 1.04-22.67, low strength of evidence). With regard to preventing mortality, EUS-CYA ranked the highest (P = .83) and beta-blocker ranked the lowest (P = .14).
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Osman KT, et al. Abstract S632. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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