This article is more than 5 years old. Information may no longer be current.

Stents control acute bleeding better vs. balloon tamponade in cirrhosis

Esophageal metal stents were more effective in controlling acute bleeding from varices in patients with cirrhosis and esophageal variceal bleeding and other adverse events vs. balloon tamponade, according to results of a controlled trial.

“Our findings favor a greater use of esophageal stents in patients with esophageal [acute bleeding from esophageal varices] uncontrolled with medical and endoscopic treatment,” Àngels Escorsell, MD, of the ICU–Liver Unit, Hospital Clínic, Barcelona, Spain, and colleagues wrote.

The researchers randomly assigned 28 patients from nine teaching hospitals in Spain to undergo SX-ELLA Danis stent (n = 13) or Sengstaken-Blakemore tube (n = 15) therapy. All patients had been previously admitted to a hospital between March 2009 and January 2013 for cirrhosis and suspected acute bleeding from esophageal varices (AVB).

“We hypothesized that the use of self-expandable esophageal stents could provide a better balance of benefits and harms than balloon tamponade,” the researchers wrote.

Results showed more patients in the esophageal stent group had successful therapy (66%) compared with patients in balloon tamponade group (20%; P = .025). The probability of being treatment failure-free during the first 15 days after treatment was higher in patients who used stents (61.5%) compared with balloon tamponade (20%; P = .056).

Controlled bleeding was also higher in the stent group compared with the balloon tamponade group (85% vs. 47%; P = .037). However, no significant differences were observed between the groups at 6 weeks.  

“The lack of differences between [absence of bleeding between the] groups at 6 weeks is likely to have been influenced by the more frequent use of [transjugular intrahepatic portosystemic shunt placement] as a rescue therapy in the tamponade group,” the researchers wrote, adding that more patients in the balloon tamponade used transjugular intrahepatic portosystemic shunt placement (TIPS; n = 10) vs. the stents group (n = 4).

Researchers observed fewer transfusional requirements (P = .08) and less severe adverse advents (15% vs. 47%; P = .077) in the esophageal stent group compared with the balloon tamponade group, but this did not reach significant significance.

There were no significant differences in 15-day (69% vs. 47%) or 6-week survival between the groups (54% vs. 40%).

The researchers concluded: “Even in the context of the short number of patients included, this [randomized controlled trial] shows that self-expandable, covered esophageal metal stents are more effective than balloon tamponade for the temporary control of massive or refractory esophageal AVB in patients with cirrhosis of the liver. … This procedure would be specially valuable for centers without facilities for early TIPS.” – by Melinda Stevens

Disclosure: Escorsell reports no relevant financial disclosures. Please see the study for a list of all other researchers’ relevant financial disclosures.