Duration of vasoconstrictors after endoscopic variceal ligation in acute variceal bleeding: A systematic review and...

Studies on the duration of vasoconstrictors after endoscopic variceal ligation (EVL) for acute variceal bleeding (AVB) have shown varying results. The present network meta-analysis compared the effectiveness of vasoconstrictors after EVL based on the therapy duration.

The electronic databases of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched from inception to March 2024 for randomized studies comparing the duration of vasoconstrictors in AVB after EVL (Group 1: ≤24 hours, Group 2: >24 to ≤72 hours, Group 3: >72 to ≤120 hours). Rebleeding and mortality risk were analyzed using pairwise and network meta-analyses.

Eleven studies (n=1,066) met the inclusion criteria. Rebleeding rates varied from 0-38% in Group 1, 2-12% in Group 2, and 0-26% in Group 3. There was no difference in the risk of rebleeding in Group 1 (risk ratio [RR]: 1.36, 95% confidence interval [CI]: 0.48-3.52) or Group 2 (RR: 1.34, 95% CI: 0.42-4.54), compared to Group 3. Similarly, there was no difference either in 5-day mortality risk among the groups (RR: 0.66, 95% CI: 0.09-2.52 and 1.08, 95% CI: 0.15-6.43 for Groups 1 and 2, respectively, vs. Group 3) or 30-day mortality risk (RR: 1.18, 95% CI: 0.51-2.51 and 0.98, 95% CI: 0.36-2.52 for Groups 1 and 2, respectively, vs. Group 3).

The current network meta-analysis provides no evidence to support the use of vasoconstrictors following EVL. These data suggest that vasoconstrictors can be stopped early after EVL, facilitating early discharge from the hospital.