Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Prevención secundaria de la hemorragia por várices en adultos con hemorragia previa por várices esofágicas debido a cirrosis hepática descompensada: un metanálisis en red
Maria Corina Plaz Torres, Lawrence MJ Best, Suzanne C Freeman, Danielle Roberts, Nicola J Cooper, Alex J Sutton, Davide Roccarina, Amine Benmassaoud, Laura Iogna Prat, Norman R Williams, Mario Csenar, Dominic Fritche, Tanjia Begum, Sivapatham Arunan, Maxine Tapp, Elisabeth Jane Milne, Chavdar S Pavlov, Brian R Davidson, Emmanuel Tsochatzis, Kurinchi Selvan Gurusamy | 30 marzo 2021
Prevención primaria de la hemorragia por várices en personas con várices esofágicas debido a cirrosis hepática: un metanálisis en red
Davide Roccarina, Lawrence MJ Best, Suzanne C Freeman, Danielle Roberts, Nicola J Cooper, Alex J Sutton, Amine Benmassaoud, Maria Corina Plaz Torres, Laura Iogna Prat, Mario Csenar, Sivapatham Arunan, Tanjia Begum, Elisabeth Jane Milne, Maxine Tapp, Chavdar S Pavlov, Brian R Davidson, Emmanuel Tsochatzis, Norman R Williams, Kurinchi Selvan Gurusamy | 6 abril 2021

Topics

Temas

Funnel plot of shunt therapy versus endoscopic therapy, showing bias in favour of shunt therapy.
Figuras y tablas -
Figure 1

Funnel plot of shunt therapy versus endoscopic therapy, showing bias in favour of shunt therapy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of shunt therapy versus endoscopic therapy, showing no bias in favour of shunt therapy on hepatic encephalopathy.
Figuras y tablas -
Figure 2

Funnel plot of shunt therapy versus endoscopic therapy, showing no bias in favour of shunt therapy on hepatic encephalopathy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of shunt therapy versus endoscopic therapy, showing no bias in favour of shunt therapy on chronic hepatic encephalopathy.
Figuras y tablas -
Figure 3

Funnel plot of shunt therapy versus endoscopic therapy, showing no bias in favour of shunt therapy on chronic hepatic encephalopathy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of shunt therapy versus endoscopic therapy, showing no bias in favour of shunt therapy on mortality.
Figuras y tablas -
Figure 4

Funnel plot of shunt therapy versus endoscopic therapy, showing no bias in favour of shunt therapy on mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 1 Rebleeding (hazard ratio).
Figuras y tablas -
Analysis 1.1

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 1 Rebleeding (hazard ratio).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 2 Rebleeding.
Figuras y tablas -
Analysis 1.2

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 2 Rebleeding.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 3 Development of hepatic encephalopathy (hazard ratio).
Figuras y tablas -
Analysis 1.3

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 3 Development of hepatic encephalopathy (hazard ratio).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 4 Hepatic encephaloapthy.
Figuras y tablas -
Analysis 1.4

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 4 Hepatic encephaloapthy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 5 Chronic hepatic encephalopathy.
Figuras y tablas -
Analysis 1.5

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 5 Chronic hepatic encephalopathy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 6 Duration of in‐patient stay (days).
Figuras y tablas -
Analysis 1.6

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 6 Duration of in‐patient stay (days).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 7 Mortality (hazard ratio).
Figuras y tablas -
Analysis 1.7

Comparison 1 Shunt therapy versus endoscopic therapy, Outcome 7 Mortality (hazard ratio).

Ir a la figura de la revisiónAbrir en una pestaña nueva
Table 1. TS versus ET, shunt surveillance and complications

Trial

SH surveillance

SH dysfunction

SH complications

ET complications

Planas 1991

Angiography or ultrasound 3‐10 months later or at the time of rebleeding.

1/41 [percentage and 95% CI: 2(0.4 to 13)%]

Wound abscess 2, Sepsis 1, pneumonia 2, chylous pleural effusion 1, cholestasis 1

Ulcers 3, stenosis 1, pneumonia 1, dysphagia 4.

Isaksson 1996

Angiography at 4 months then annual ultrasound.

1/24 [percentage and 95% CI: 4(0.7 to 20)%]

Oesophagitis 8.

Oesophageal stenosis 2, oesophagitis 7.

Cello 1987

Not mentioned.

Not mentioned.

Not mentioned.

Not mentioned.
Figuras y tablas -
Table 1. TS versus ET, shunt surveillance and complications
Ir a la tabla de la revisión
Table 2. DSRS versus ET, shunt surveillance and complications

Trial

SH surveillance

SH dysfunction

SH complications

ET complications

Henderson 1990

Not mentioned.

1/35 [percentage and 95% CI: 3(0.5 to 15)%]

Not mentioned.

Not mentioned.

Rikkers 1993

Angiography 3 months and then 1, 3, and 6 years.

3/30 [percentage and 95% CI: 10(4 to 26)%]

Not mentioned.

Stenosis 2.

Spina 1990

Angiography 10th day, 1, 3, and 6 months and then 6 monthly for 2 years.

0/20 [percentage and 95% CI: 0(0 to 16)%]

Intestinal obstruction (one death).

Ulcers 2, stenosis 2, dysphagia 5.

Teres 1987

Angiography or ultrasound or splenoportography 7 to 10 months after surgery or when rebleeding.

6/43 [percentage and 95% CI: 14(7 to 27)%]

Not mentioned.

Ulcers 2, stenosis 3, dysphagia 15.
Figuras y tablas -
Table 2. DSRS versus ET, shunt surveillance and complications
Ir a la tabla de la revisión
Table 3. TIPS versus ET, shunt surveillance and complications

Trial

SH surveillance

SH dysfunction

SH complications

ET complications

Cabrera 1996

Angiography 6 monthly.

15/26 [percentage and 95% CI: 58(39 to 75)%]

Portal thrombosis 2, spontaneous bacterial peritonitis 2, haemobilia 1, sepsis 1.

Ulcers 5, stenosis 4, pneumonia 2, sepsis 1, spontaneous bacterial peritonitis 2.

Cello 1997

Duplex ultrasound.

4/22 [percentage and 95% CI: 18(7 to 39)%]

Not mentioned.

Not mentioned.

Garcia‐V 1999

Angiography at 1 and 6 months.

13/18 [percentage and 95% CI: 72(49 to 88)%]

Not mentioned.

Ulcers 5, stenosis 1.

Jalan 1997

Duplex ultrasound at 1 week, angiography at 1 and 6 months, and then 6 monthly.

9/28 [percentage and 95% CI: 32(18 to 51)%]

Sepsis 3, perforation of the capscule 1 (death).

Ulcers 12, sepsis 4, pneumonia 2.

Merli 1998

Duplex ultrasound 6 monthly and angiography 6 monthly.

21/33 [percentage and 95% CI: 64(47 to 78)%]

Haemolysis 1, intra‐hepatic haematoma 1, cardiac arrest 1, pulmonary embolism 1.

Ulcers 2, stenosis 2, pneumonia 1, stroke 1.

Rossle 1997

Duplex ultrasound at 1, 3, 6, 9, and 12 months and then 6 monthly.

18/60 [percentage and 95% CI: 30(20 to 43)%]

Stent migration 1, haemobilia 3, haemoperitoneum 2, bleeding in the liver 1 and sepsis 1.

Ulcers 8, dysphagia 5, mediastinitis 1, hypopyon 1.

Sanyal 1997

Duplex ultrasound at day 1, first week, 1 and 3 months and then 3 monthly.

20/34 [percentage and 95% CI: 59(42 to 74)%]

Haemolysis 5.

Ulcers 22, stenosis 3, dysphagia 5.

Sauer 1997

Duplex ultrasound every 3 months and angiography every 3 months.

29/42 [percentage and 95% CI: 69(54 to 81)%]

Shunt dislocation 4.

Ulcers 19, haemorrhage 5.

G‐P Layrargues 2001

Duplex ultrasound at 24 hours and then 3 monthly for two years.

24/41 [percentage and 95% CI: 59(43 to 72)%]

Haemoperitoneum causing death 1, 30 episodes of shunt dysfunction in 24. patients.

Sepsis 2.

GDEAIH 1995

Information not reported in abstract.

Information not reported.

Information not reported.

Information not reported.

Sauer 1998

Information not reported in abstract.

Reported as 56% after one year'.

Information not reported.

Information not reported.

Sauer 2002

Angiography or Duplex scanning every 3 months.

Cumulative dysfunction 89% during follow‐up, re‐intervention rate 62%.

pneumonia (4 patients), haemobilia (2 patients), stent dislocation (1 patient).

Dysphagia 3, pneumonia 3, septicaemia 2, post‐therapeutic haemorrhage 2.

Gulberg 2002

Three monthly doppler sonography.

Not mentioned.

Perforation of liver capsule 1 (death).

Perforation of oesophagus 1.

Nahara 2001

Three monthly duplex scanning.

Shunt dysfunction 71%.

Haemobilia 2, segmental hepatic infarction 1.

Dysphagia 2, pleural effusion 6, oesophageal stenosis requiring dilatation 1.
Figuras y tablas -
Table 3. TIPS versus ET, shunt surveillance and complications
Ir a la tabla de la revisión
Comparison 1. Shunt therapy versus endoscopic therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Rebleeding (hazard ratio) Show forest plot

11

835

Peto Odds Ratio (95% CI)

0.42 [0.32, 0.54]

1.1 Total shunts versus endoscopic therapy

0

0

Peto Odds Ratio (95% CI)

0.0 [0.0, 0.0]

1.2 DSRS versus endoscopic therapy

0

0

Peto Odds Ratio (95% CI)

0.0 [0.0, 0.0]

1.3 TIPS versus endoscopic therapy

11

835

Peto Odds Ratio (95% CI)

0.42 [0.32, 0.54]

2 Rebleeding Show forest plot

21

1487

Odds Ratio (M‐H, Fixed, 95% CI)

0.24 [0.18, 0.30]

2.1 Total shunt versus endoscopic therapy

3

191

Odds Ratio (M‐H, Fixed, 95% CI)

0.09 [0.03, 0.23]

2.2 DSRS versus endoscopic therapy

4

262

Odds Ratio (M‐H, Fixed, 95% CI)

0.13 [0.07, 0.26]

2.3 TIPS versus endoscopic therapy

14

1034

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.22, 0.39]

3 Development of hepatic encephalopathy (hazard ratio) Show forest plot

10

725

Peto Odds Ratio (95% CI)

1.96 [1.47, 2.61]

3.1 Total shunts versus endoscopic therapy

0

0

Peto Odds Ratio (95% CI)

0.0 [0.0, 0.0]

3.2 DSRS versus endoscopic therapy

0

0

Peto Odds Ratio (95% CI)

0.0 [0.0, 0.0]

3.3 TIPS versus endoscopic therapy

10

725

Peto Odds Ratio (95% CI)

1.96 [1.47, 2.61]

4 Hepatic encephaloapthy Show forest plot

19

1338

Odds Ratio (M‐H, Fixed, 95% CI)

2.07 [1.59, 2.69]

4.1 Total shunt versus endoscopic therapy

3

179

Odds Ratio (M‐H, Fixed, 95% CI)

1.54 [0.67, 3.54]

4.2 DSRS versus endoscopic therapy

3

190

Odds Ratio (M‐H, Fixed, 95% CI)

1.75 [0.83, 3.69]

4.3 TIPS versus endoscopic therapy

13

969

Odds Ratio (M‐H, Fixed, 95% CI)

2.20 [1.63, 2.98]

5 Chronic hepatic encephalopathy Show forest plot

14

991

Odds Ratio (M‐H, Fixed, 95% CI)

2.09 [1.20, 3.62]

5.1 Total shunts versus endoscopic therapy

1

69

Odds Ratio (M‐H, Fixed, 95% CI)

7.89 [0.39, 158.73]

5.2 DSRS versus endoscopic therapy

4

245

Odds Ratio (M‐H, Fixed, 95% CI)

1.29 [0.51, 3.29]

5.3 TIPS versus endoscopic therapy

9

677

Odds Ratio (M‐H, Fixed, 95% CI)

2.45 [1.19, 5.03]

6 Duration of in‐patient stay (days) Show forest plot

9

679

Mean Difference (IV, Random, 95% CI)

0.79 [‐1.48, 3.05]

6.1 Total shunts versus endoscopic therapy

1

82

Mean Difference (IV, Random, 95% CI)

3.10 [‐2.38, 8.58]

6.2 DSRS versus endoscopic therapy

1

90

Mean Difference (IV, Random, 95% CI)

‐3.40 [‐13.71, 6.91]

6.3 TIPS versus endoscopic therapy

7

507

Mean Difference (IV, Random, 95% CI)

0.64 [‐1.95, 3.23]

7 Mortality (hazard ratio) Show forest plot

19

1358

Peto Odds Ratio (95% CI)

1.00 [0.82, 1.21]

7.1 Total shunts versus endoscopic therapy

3

191

Peto Odds Ratio (95% CI)

1.03 [0.68, 1.56]

7.2 DSRS versus endoscopic therapy

4

284

Peto Odds Ratio (95% CI)

0.88 [0.59, 1.31]

7.3 TIPS versus endoscopic therapy

12

883

Peto Odds Ratio (95% CI)

1.04 [0.80, 1.36]
Figuras y tablas -
Comparison 1. Shunt therapy versus endoscopic therapy
Ir a la tabla de la revisión