Cochrane · systematic review · CD013122
Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta‐analysis
Plaz Torres, MCorina, Best, LMJ, Freeman, SC, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Hepato-BiliaryAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
40
current version
GRADE rated
38
No studies
2
Included studies
NR
No studies 2 · 5%Ungraded 0 · 0%Very low 8 · 20%Low 23 · 57.5%Moderate 7 · 17.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Secondary prevention of bleeding in people with previous oesophageal variceal bleeding due to decompensated liver cirrhosis (all interventions)
Population: people with liver cirrhosis and previous oesophageal variceal bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Interventions | no estimate extracted | NR | No studies |
Sclerotherapy | no estimate extracted | NR | No studies |
Beta‐blockers(9 RCTs; 493 participants) | HR 0.88 [0.66, 1.18] | NR | Low Downgraded: risk of bias, imprecision |
Variceal band ligation(5 RCTs; 399 participants) | HR 0.95 [0.62, 1.46] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Sclerotherapy(8 RCTs; 370 participants) | HR 0.69 [0.43, 1.09] | NR | Low Downgraded: risk of bias, imprecision |
No active intervention(4 RCTs; 412 participants) | HR 1.2 [0.83, 1.84] | NR | Low Downgraded: risk of bias, imprecision |
TIPS(3 RCTs; 189 participants) | HR 0.94 [0.56, 1.59] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Nitrates(No direct RCT) | HR 0.91 [0.53, 1.58] | NR | Low Downgraded: risk of bias, imprecision |
Portocaval shunt(2 RCTs; 100 participants) | HR 1.21 [0.68, 2.15] | NR | Low Downgraded: risk of bias, imprecision |
Sclerotherapy plus Variceal band ligation(No direct RCT) | HR 0.78 [0.35, 1.76] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Nitrates plus Variceal band ligation(No direct RCT) | HR 0.89 [0.4, 1.98] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Variceal band ligation(No direct RCT) | HR 0.83 [0.22, 3.05] | NR | Low Downgraded: risk of bias, imprecision |
Sclerotherapy plus Nitrates(1 RCT; 76 participants) | HR 0.19 [0.02, 0.86] | NR | Moderate Downgraded: risk of bias |
Beta‐blockers(1 RCT; 91 participants) | OR 0.47 [0.13, 1.53] | NR | Very low Downgraded: risk of bias, imprecision |
Variceal band ligation(1 RCT; 100 participants) | OR 0.19 [0.06, 0.53] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Sclerotherapy(No direct RCT) | OR 1.29 [0.28, 5.7] | NR | Very low Downgraded: risk of bias, imprecision |
Beta‐blockers(No direct RCT) | OR 11.86 [1.16, 427.95] | NR | Low Downgraded: risk of bias, imprecision |
Variceal band ligation(3 RCTs; 215 participants) | OR 0.39 [0.16, 1.09] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Sclerotherapy(2 RCTs; 71 participants) | OR 1.46 [0.36, 6.06] | NR | Low Downgraded: risk of bias, imprecision |
No active intervention(1 RCT; 40 participants) | OR 0.22 [0.05, 0.86] | NR | Low Downgraded: risk of bias, imprecision |
TIPS(No direct RCT) | OR 0.02 [0, 0.17] | NR | Low Downgraded: risk of bias, imprecision |
Variceal band ligation(2 RCTs; 188 participants) | Rate ratio 0.4 [0.26, 0.61] | NR | Moderate Downgraded: risk of bias |
Beta‐blockers plus Sclerotherapy(2 RCTs; 128 participants) | Rate ratio 0.93 [0.68, 1.26] | NR | Low Downgraded: risk of bias, imprecision |
TIPS(1 RCT; 63 participants) | Rate ratio 1.1 [0.73, 1.66] | NR | Low Downgraded: risk of bias, imprecision |
Portocaval shunt(1 RCT; 45 participants) | Rate ratio 0.87 [0.34, 2.28] | NR | Low Downgraded: risk of bias, imprecision |
Variceal band ligation(1 RCT; 111 participants) | HR 0.94 [0.03, 35.27] | NR | Very low Downgraded: risk of bias, imprecision |
Beta‐blockers plus Sclerotherapy(1 RCT; 40 participants) | HR 1.26 [0.17, 10.1] | NR | Very low Downgraded: risk of bias, imprecision |
TIPS(1 RCT; 80 participants) | HR 1.52 [0.39, 6.6] | NR | Very low Downgraded: risk of bias, imprecision |
Beta‐blockers(1 RCT; 28 participants) | HR 0.46 [0, 43.25] | NR | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
No active intervention(No direct RCT) | HR 1.19 [0, 1726.76] | NR | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Beta‐blockers(6 RCTs; 420 participants) | HR 1.62 [1.14, 2.38] | NR | Moderate Downgraded: risk of bias |
Variceal band ligation(2 RCTs; 111 participants) | HR 1.61 [0.72, 3.77] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers plus sclerotherapy(4 RCTs; 231 participants) | HR 0.6 [0.37, 0.95] | NR | Moderate Downgraded: risk of bias |
No active intervention(3 RCTs; 296 participants) | HR 1.61 [1.01, 2.86] | NR | Moderate Downgraded: risk of bias |
TIPS(2 RCTs; 109 participants) | HR 0.18 [0.08, 0.38] | NR | Moderate Downgraded: risk of bias |
Beta‐blockers plus nitrates(No direct RCT) | HR 2.13 [0.79, 5.86] | NR | Low Downgraded: risk of bias, imprecision |
Portocaval shunt(No direct RCT) | HR 0.21 [0.05, 0.77] | NR | Moderate Downgraded: risk of bias |
Sclerotherapy plus variceal band ligation(No direct RCT) | HR 1.83 [0.46, 7.4] | NR | Low Downgraded: risk of bias, imprecision |
Beta‐blockers(1 RCT; 65 participants) | Rate ratio 2.4 [1.35, 4.55] | NR | Low Downgraded: risk of bias, imprecision |
Variceal band ligation(No direct RCT) | Rate ratio 1.92 [0.31, 10.62] | NR | Very low Downgraded: risk of bias, imprecision |