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Semin Liver Dis 2019; 39(02): 178-194
DOI: 10.1055/s-0039-1678726
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Balloon Tamponade and Esophageal Stenting for Esophageal Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-analysis

Susana G. Rodrigues
1   Swiss Liver Center, UVCM, Inselspital, Bern University Hospital, Department of Biomedical Research, University of Bern, Bern, Switzerland
,
Andrés Cárdenas
2   GI/Liver Unit, Institute of Digestive Diseases and Metabolism, University of Barcelona, Barcelona, Spain
4   Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
,
Àngels Escorsell
3   Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
4   Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
5   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
,
Jaime Bosch
1   Swiss Liver Center, UVCM, Inselspital, Bern University Hospital, Department of Biomedical Research, University of Bern, Bern, Switzerland
4   Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
› Author Affiliations
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Publication History

Publication Date:
25 March 2019 (online)

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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

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