Acute esophageal variceal bleeding: Current strategies and new perspectives

Table 1 Most relevant prognostic studies in acute variceal bleeding published between 1999-2009

Authors (year)(Ref.)	n	Universal antibiotic prophylaxis	Hemostatictreatment	Early rebleeding/treatment failure	Prognostic factors for rebleeding/treatment failure	Early mortality	Prognostic factors for early mortality	Statistical technique	Validation of prognostic models
Ben Ari et al (1999)[13]	529	No	EST or VAD (+ EST if failure)	224 (42%)	Active bleeding at endoscopy, platelet count, time to admission, alcohol, heart rate, encephalopathy	92 (17%)	Encephalopathy, bilirubin, ascites, plasma urea, heart rate, 5 d failure	Cox regression	Yes (bootstrapping)
Moitinho et al (1999)[14]	65	No	EST or VAD	23 (35%)	HVPG ≥ 20 mmHg	6 (9%)	Not reported	Logistic regression	No
D’Amico et al (2003)[6]	297	No	VAD, Endoscopy or combination	49 (15%)	Child, portal vein thrombosis, AST, active bleeding, transfusion volume	70 (21%)	Encephalopathy, bilirubin, HCC, albumin	Logistic regression	Yes (split sample)
Thomopoulous et al (2003)[15]	121	No	VAD + EVL	15 (10%)	Not reported	26 (18%)	Child, shock	Logistic regression	No
Lecleire et al (2005)[16]	275	No	Endoscopy	Not reported	Not reported	107 (23%)	Prothrombin time, digestive cancer, hematemesis, corticoids, age, in-patients	Logistic regression	No
Abraldes et al (2008)[14]	117	Yes	VAD + Endoscopy	18 (15%)	HVPG ≥ 20 mmHg, shock, Child, non-alcoholic cirrhosis	7 (6%)	Not reported	Logistic regression	Yes (bootstrapping)
Bambha et al (2008)[12]	256	Yes	EVL + (VAD or placebo)	37 (15%)	MELD ≥ 18, clot on varix	35 (14%)	MELD ≥ 18, transfusion volume, active bleeding at endoscopy, early rebleeding	Bivariate cox analysis	No
Augustin et al (2009)[5]	267	Yes	VAD + Endoscopy	55 (21%)	Not reported	63 (24%)	Child, infection, plasma creatinine, HCC	Logistic regression + CART analysis	Yes (split sample)

n: total number of patients (only those with variceal bleeding considered); EST: endoscopic sclerotherapy; EVL: endoscopic variceal ligation; VAD: vasoactive drug; HVPG: hepatic venous pressure gradient; AST: aspartate aminotransferase; HCC: hepatocellular carcinoma; CART: classification and regression tree; Ref: references.

Table 2 Analysis of pooled data of the only two studies in acute variceal bleeding comparing combined therapy vs endoscopy alone in which endoscopic variceal ligation was used as endoscopic modality

	VAD + EVL n/N (%)	EVL n/N (%)
Calés et al[92]	14/98 (14)	21/98 (21)
Sung et al[91]	5/47 (11)	11/47 (23)
Total	19/145 (13)	32/145 (22)

Absolute risk difference for combined therapy: -9.0%, CI95 1.7%-17.7%; RR: 0.59, CI95 0.35-0.99, P = 0.045. In the study by Calés et al, EVL was not performed in all patients (the exact percentage of patients receiving EVL or EST is not provided). VAD: vasoactive drug; EVL: endoscopic variceal ligation; EST: endoscopic sclerotherapy; n/N: number of events/number of patients in each treatment arm; CI95: 95% confidence interval.