Abstract
Failure to control variceal bleeding with current recommendations occurs in 10 to
20% of cases. This systematic review and meta-analysis analyzes the experience, results,
and complications of “bridge” therapies for failure to control acute variceal bleeding:
balloon tamponade and esophageal stents. The main outcomes assessed were failure to
control bleeding and mortality in the short-term and medium-term follow-up, and adverse
events. Balloon tamponade studies had a pooled rate of short-term failure to control
bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death.
Stenting failed to control bleeding in the short term and medium term in 12.7 and
21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent
migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies.
Although only one trial compared these treatments, the available evidence consistently
supports that stents serve as a better and safer bridge therapy in refractory acute
variceal bleeding.
Keywords
cirrhosis - esophageal varices - refractory variceal bleeding - self-expanding metallic
stent - Sengstaken-Blakemore tube
