RESUMO
BACKGROUND AND AIMS: Post-banding ulcer bleeding (PBUB) is an understudied complication of oesophageal varices endoscopic band ligation (EBL). This systematic review with meta-analysis aimed at: (a) evaluating the incidence of PBUB in patients with cirrhosis treated with EBL in primary or secondary prophylaxis or urgent treatment for acute variceal bleeding and (b) identifying predictors of PBUB. METHODS: We conducted a systematic review of articles in English published in 2006-2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were made in eight databases including Embase, PubMed and Cochrane Library. Random-effects meta-analysis was used to determine the incidence, mean interval and predictors of PBUB. RESULTS: Eighteen studies (9034 patients) were included. The incidence of PBUB was 5.5% (95% CI 4.3-7.1). The mean time for it to occur was 11 days (95% CI 9.94-11.97). Model for End-stage Liver Disease (MELD) score (OR 1.162, 95% CI 1.047-1.291) and EBL done in emergency setting (OR 4.902, 95% CI 2.99-8.05) independently predicted post-ligation ulcer bleeding. Treatment included drugs, endoscopic procedures and transjugular intrahepatic portosystemic shunt. Refractory bleeding was treated with self-expandable metallic stents or balloon tamponade. Mortality was on average 22.3% (95% CI 14.1-33.6). CONCLUSIONS: Patients with high MELD score and receiving EBL in an emergency setting are more prone to develop PBUB. Prognosis is still poor and the best therapeutic strategy to address remains to be ascertained.
Assuntos
Doença Hepática Terminal , Varizes Esofágicas e Gástricas , Derivação Portossistêmica Transjugular Intra-Hepática , Humanos , Varizes Esofágicas e Gástricas/terapia , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Úlcera/terapia , Úlcera/complicações , Doença Hepática Terminal/etiologia , Índice de Gravidade de Doença , Cirrose Hepática/complicações , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Ligadura/efeitos adversosRESUMO
Polypharmacy and Potentially Inappropriate Medication (PIM) are major public health concerns. They are associated with higher morbi-mortality and a socio-economic burden. The medication review is a solution to limit PIM, especially in the elderly, and in cases of poly-morbidity. Many tools are available to support medication review. We will introduce here the Beers criteria, the PRISCUS list, the STOPP/START criteria, the MAI (Medication Appropriateness Index) and the Good-Palliative-Geriatric Practice Algorithm.
La polypharmacie et la prescription médicamenteuse inappropriée (PMI) sont des problèmes majeurs de santé publique. Elles sont associées à une augmentation de la morbimortalité et représentent un fardeau socio-économique. La révision médicamenteuse est une solution pour limiter les PMI qui sont présentes majoritairement chez le patient âgé et polymorbide. De nombreux outils sont disponibles dans le processus de revue médicamenteuse. Nous présenterons ici les critères de Beers, la liste PRISCUS, les critères STOPP/START (Screening Tool of Older Persons' Potentially Inappropriate Prescriptions/Screening Tool to Alert Doctors to the Right Treatment), le MAI (Medication Appropriatness Index) et l'algorithme GP-GP (Good-Palliative-Geriatric Practice).
Assuntos
Prescrição Inadequada , Polimedicação , Idoso , Humanos , Lista de Medicamentos Potencialmente InapropriadosRESUMO
Coagulation disorders related to abnormalities in hepatic synthesis are well known as prognostic factors in hepatic cirrhosis. The risk of bleeding, mainly linked to portal hypertension, must be weighed against the risk of thrombosis, the most frequent manifestation of which is portal venous thrombosis. Conventional laboratory tests are not a reliable reflection of this delicate balance. The use of prophylactic anticoagulation in hospitalized patients with decompensated hepatic cirrhosis or therapeutic anticoagulation in venous thrombosis is recommended in most cases, in the absence of contraindications.
Les troubles de la coagulation liés aux anomalies de la synthèse hépatique sont bien connus comme facteurs pronostiques de la cirrhose hépatique. Le risque hémorragique, principalement lié à l'hypertension portale, est à mettre en balance avec le risque thrombotique, dont la manifestation la plus fréquente est la thrombose veineuse porte. Les tests de laboratoire classiques ne sont pas un reflet fiable de cet équilibre fragile. L'utilisation d'une anticoagulation prophylactique chez les patients hospitalisés avec cirrhose hépatique décompensée ou d'une anticoagulation thérapeutique en cas de thrombose veineuse est recommandée dans la plupart des cas, en l'absence de contre-indications.
