肝硬化门静脉高压食管胃静脉曲张出血的防治指南

doi:10.3969/j.issn.1672-5069.2023.02.039

摘要/Abstract

摘要： 为了规范肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理,中华医学会肝病学分会、消化病学分会和消化内镜学分会组织国内有关专家,结合近年来国内外肝硬化门静脉高压食管胃静脉曲张出血相关临床研究的最新进展,遵循循证医学的证据,修定了《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》,对肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理提出了推荐意见,旨在提高临床医生对于肝硬化门静脉高压食管胃静脉曲张出血的临床救治水平。

关键词: 指南, 管理, 食管胃静脉曲张出血, 肝硬化, 门静脉高压

Abstract: In order to standardize the diagnosis, treatment and management of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension, the Chinese Society of Hepatology, Chinese Society of Gastroenterology, and Chinese Society of Digestive Endoscopology of Chinese Medical Association organized relevant experts, revieweddomestic and international latest progress in clinical research on EVB in cirrhotic portal hypertension, and followed the evidence of evidence-based medicine toupdate the Guidelines on the Management of EVB in Cirrhotic Portal Hypertension. The guidelineprovides recommendations for the diagnosis, treatment and management of EVB in cirrhotic portal hypertension and aims to improve the level of clinical treatment of EVB in cirrhotic portal hypertension.

Key words: Guideline, Management, EVB, Cirrhosis, Portal Hypertension

中华医学会肝病学分会中华医学会消化病学分会中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 实用肝脏病杂志, 2023, 26(2): 0-S4.

Chinese Society of Hepatology, Chinese Society of Gastroenterology, and Chinese Society of Digestive Endoscopology of Chinese Medical Association. Guidelines on the Management of EVB in Cirrhotic Portal Hypertension[J]. Journal of Practical Hepatology, 2023, 26(2): 0-S4.

参考文献

[1] 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治共识[J]. 中华肝脏病杂志, 2008, 16): 564-570. DOI: 10.3321/j.issn:1007-3418.2008.08.002.
[2] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
[3] European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
[4] Biggins S W, Angeli P, Garcia‐Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74(2): 1014-1048.
[5] Aithal G P, Palaniyappan N, China L, et al. Guidelines on the management of ascites in cirrhosis[J]. Gut, 2021, 70(1): 9-29.
[6] Tripathi D, Stanley A J, Hayes P C, et al. U. K. guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut, 2015, 64(11): 1680-1704.
[7] De Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension[J]. J Hepatol, 2021,
[8] 徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425.
[9] Hu Z, Li Y, Li C, et al. Using Ultrasonic Transient Elastometry (FibroScan) to Predict Esophageal Varices in Patients with Viral Liver Cirrhosis[J]. Ultrasound Med Biol, 2015, 41(6): 1530-1537.
[10] Pons M, Augustin S, Scheiner B, et al. Noninvasive diagnosis of portal hypertension inpatients with compensated advanced chronic liverdisease[J]. Am J Gastroenterol 2021; 116: 723-732.
[11] 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会, 等. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版)[J]. 中华肝脏病杂志, 2019 (03): 182-191.
[12] Li Y, Li L, Liebe R, et al. Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients: A systematic review and meta-analysis.. World J Gastroenterol. 2020, 26(18): 2247-2267.
[13] Kim SH, Kim YJ, Lee JM, et al. Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy[J]. Radiology. 2007. 242(3): 759-68.
[14] Hwang J H, Shergill A K, Acosta R D, et al. The role of endoscopy in the management of variceal hemorrhage[J]. Gastrointest Endosc, 2014, 80(2): 221-227.
[15] Hammoud G M, Ibdah J A. Utility of endoscopic ultrasound in patients with portal hypertension[J]. World J Gastroenterol, 2014, 20(39): 14230-14236.
[16] 李敏然, 徐小元. 肝硬化门静脉高压食管胃静脉曲张出血的防治研究[J]. 中华肝脏病杂志, 2015, 23(04): 247-249.
[17] MorrisonJ. D, Mendoza-EliasN, LipnikAJ, et aI. Gastric Varices Bleed at Lower Portosystemic Pressure Gradients than Esophageal Varices[J]. J Vasc Interv Radiol, 2018 29(5). 636-641
[18] D'amico G, Pasta L, Morabito A, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients[J]. Aliment Pharmacol Ther, 2014, 39(10): 1180-1193.
[19] De Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752.
[20] Qi X, Dai J, Yang M, et al. Association between Portal Vein Thrombosis and Survival in Non-Liver-Transplant Patients with Liver Cirrhosis: A Systematic Review of the Literature[J]. Gastroenterol Res Pract, 2015, 2015(480842.
[21] Asrani S K, Kamath P S. Prediction of early mortality after variceal bleeding: score one more for MELD[J]. Gastroenterology, 2014, 146(2): 337-339.
[22] 令狐恩强. 2009静脉曲张及出血的内镜诊断和治疗规范试行方案注解[J]. 中华腔镜外科杂志(电子版), 2011, 4(05): 331-333.
[23] 中华医学会消化内镜学分会食管胃静脉曲张学组. 消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J]. 中国继续医学教育, 2010, 2(06): 21-26.
[24] 中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30(2): 131-136.
[25] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 035(012): 2670-2686.
[26] Ghany M G, Morgan T R. Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection[J]. Hepatology, 2020, 71(2): 686-721.
[27] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 酒精性肝病防治指南(2018更新版)[J]. 中华肝脏病杂志, 2018,
[28] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 实用肝脏病杂志, 2018, 21(02): 30-39.
[29] 中华医学会肝病学分会. 自身免疫性肝炎诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 8.
[30] 中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]. 中华内科杂志, 2021, 60(12): 14.
[31] 中华医学会肝病学分会. 原发性硬化性胆管炎诊断及治疗指南(2021)[J]. 中华内科杂志, 2021, 60(12): 25.
[32] 黄昂, 梁庆升, 孙颖, 等. 慢性药物性肝损伤的诊治研究进展[J]. 传染病信息, 2018, 31(2): 3.
[33] 中华医学会感染病学分会, 肝脏炎症及其防治专家共识专家委员会. 肝脏炎症及其防治专家共识[J]. 中华肝脏病杂志, 2014, 22(2): 94-103.
[34] Liu Y-Q, Zhang C, Li J-W, et al. An-Luo-Hua-Xian Pill Improves the Regression of Liver Fibrosis in Chronic Hepatitis B Patients Treated with Entecavir[J]. Journal of Clinical and Translational Hepatology, 2022.
[35] 南月敏, 孔令波. 肝硬化的中西医结合诊治进展[J]. 中华肝脏病杂志, 2018, 26(5): 4.
[36] 张莹雪, 孙凤霞, 李晓玲. 安络化纤丸联合恩替卡韦治疗乙型肝炎肝硬化的系统评价[J]. 中国医院用药评价与分析, 2022, 22(1): 70.
[37] Shi K, Liu Y, Wang X, et al. Adjuvant Fuzheng Huayu Capsule Reduces the Incidence of Hepatocellular Carcinoma in Patients with Hepatitis B-Caused Cirrhosis[J]. Evidence-based Complementary and Alternative Medicine, 2020, 2020: 1-9.
[38] 杨年欢, 杨淑玲, 周元平, 等. 恩替卡韦联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化96周的临床疗效[J]. 南方医科大学学报, 2016, 36(6): 5.
[39] Xiao H-M, Shi M-J, Jiang J-M, et al. Efficacy and safety of AnluoHuaxian pills on chronic hepatitis B with normal or minimally elevated alanine transaminase and early liver fibrosis: A randomized controlled trial[J]. Journal of Ethnopharmacology, 2022, 293(115210).
[40] Wang Z, Xie Y-W, Lu Q, et al. The impact of albumin infusion on the risk of rebleeding and in-hospital mortality in cirrhotic patients admitted for acute gastrointestinal bleeding: a retrospective study of a single institute[J]. BMC Gastroenterol, 2020, 20(1): 198.
[41] Fernández J, Clària J, Amorós A, et al. Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis[J]. Gastroenterology, 2019, 157(1): 149-162.
[42] Qi X-S, Bao Y-X, Bai M, et al. Nonselective beta-blockers in cirrhotic patients with no or small varices: A meta-analysis[J]. World J Gastroenterol, 2015, 21(10): 3100-3108.
[43] Reiberger T, Ulbrich G, Ferlitsch A, et al. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol[J]. Gut, 2013, 62(11): 1634-1641.
[44] Gluud L L, Krag A. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults[J]. Cochrane Database Syst Rev, 2012, 8): CD004544.
[45] Hernández-Gea V, Aracil C, Colomo A, et al. Development of ascites in compensated cirrhosis with severe portal hypertension treated with β-blockers[J]. Am J Gastroenterol, 2012, 107(3): 418-427.
[46] Pose E, Trebicka J, Mookerjee R P, et al. Statins: Old drugs as new therapy for liver diseases?[J]. J Hepatol, 2019, 70(1): 194-202.
[47] Gluud L L, Langholz E, Krag A. Meta-analysis: isosorbide-mononitrate alone or with either beta-blockers or endoscopic therapy for the management of oesophageal varices[J]. Aliment Pharmacol Ther, 2010, 32(7): 859-871.
[48] Herath C B, Grace J A, Angus P W. Therapeutic potential of targeting the renin angiotensin system in portal hypertension[J]. World J Gastrointest Pathophysiol, 2013, 4(1):
[49] Kim D H, Park J Y. Prevention and management of variceal hemorrhage[J]. Int J Hepatol, 2013, 2013: 434609.
[50] Karadsheh Z, Allison H. Primary Prevention of Variceal Bleeding: Pharmacological Therapy Versus Endoscopic Banding[J]. North American Journal of Medical Sciences, 2013, 5(10): 573-579.
[51] De Mattos Â Z, Terra C, Farias A Q, et al. Primary prophylaxis of variceal bleeding in patients with cirrhosis: A comparison of different strategies[J]. World J Gastrointest Endosc, 2021, 13(12): 628-637.
[52] Bai M, Qi X, Yang M, et al. Combined therapies versus monotherapies for the first varicealbleeding in patients with high-risk varices: a meta-analysis of randomized controlled trials[J]. J Gastroenterol Hepatol, 2014, 29(3): 442-452.
[53] Mishra S R, Sharma B C, Kumar A, et al. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial[J]. J Hepatol, 2011, 54(6): 1161-1167.
[54] 中华医学会肝病学分会. 原发性肝癌二级预防共识(2021年版)[J]. 中华肝脏病杂志, 2021, 29(03): 216-226.
[55] O'leary J G, Greenberg C S, Patton H M, et al. AGA Clinical Practice Update: Coagulation in Cirrhosis[J]. Gastroenterology, 2019, 157(1):
[56] Drebes A, De Vos M, Gill S, et al. Prothrombin Complex Concentrates for Coagulopathy in Liver Disease: Single-Center, Clinical Experience in 105 Patients[J]. Hepatol Commun, 2019, 3(4): 513-524.
[57] Gralnek I M, Stanley A J, Morris A J, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021[J]. Endoscopy, 2021, 53(3): 300-332.
[58] Lau J Y W, Yu Y, Tang R S Y, et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding[J]. N Engl J Med, 2020, 382(14): 1299-1308.
[59] Da Hyun Jung, Cheal Wung Huh, Na Jin Kim, et al. Optimal endoscopy timing in patients with acute variceal bleeding: A systematic review and meta-analysis. Sci Rep. 2020;10(1): 4046.
[60] Seo YS, Park SY, Kim MY, et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology, 2014;60(3): 954-63.
[61] Gao Zhu-Qing, Han Ying, Li Lei, et al. Pharmacological management of portal hypertension: current status and future. Chin Med J (Engl). 2020;133(19): 2362-2364.
[62] Jha S K, Mishra M, Jha A, et al. Comparison of continuous versus intermittent infusions of terlipressin for the control of acute variceal bleeding in patients with portal hypertension: An open-label randomized controlled trial[J]. Indian J Gastroenterol, 2018, 37(4): 313-320.
[63] Triantos C, Kalafateli M, Assimakopoulos S F, et al. Endotoxin Translocation and Gut Barrier Dysfunction Are Related to Variceal Bleeding in Patients With Liver Cirrhosis[J]. Front Med (Lausanne), 2022, 9(836306.
[64] Martínez J, Hernández-Gea V, Rodríguez-De-Santiago E, et al. Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis[J]. J Hepatol, 2021, 75(2): 342-350.
[65] Lin L, Cui B, Deng Y, et al. The Efficacy of proton pump inhibitor in cirrhotics with variceal bleeding: A systemic review and meta-analysis[J]. Digestion, 2021, 102(2): 117-127.
[66] Janka T, Tornai T, Borbély B, et al. Deleterious effect of proton pump inhibitors on the disease course of cirrhosis[J]. Eur J Gastroenterol Hepatol, 2020, 32(2): 257-264.
[67] An Y, Bai Z, Xu X, et al. No Benefit of hemostatic drugs on acute upper gastrointestinal bleeding in cirrhosis[J]. Biomed Res Int, 2020, 2020: 4097170.
[68] Bates D, Edwards J, Langevin A, et al. Rebleeding in variceal and nonvariceal gastrointestinal bleeds in cirrhotic patients using Vitamin K: The LIVER-K Study[J]. Can J Hosp Pharm, 2020, 73(1): 19-26.
[69] Anand A C. Nutrition and muscle in cirrhosis[J]. J Clin Exp Hepatol, 2017, 7(4): 340-357.
[70] Wang R, Huang X, Zhou T, et al. Safety and feasibility of early oral nutrition after endoscopic treatment for patients with liver cirrhosis: A historical prospective and comparative effectiveness study[J]. JPEN J Parenter Enteral Nutr, 2022, Jan 17. doi: 10.1002/jpen.2328.
[71] Lo G-H, Lin C-W, Hsu Y-C. A controlled trial of early versus delayed feeding following ligation in the control of acute esophageal variceal bleeding[J]. J Chin Med Assoc, 2015, 78(11): 642-647.
[72] Yifei Huang, Wenhui Zhang, Huiling Xiang, et al. Treatment strategies in emergency endoscopy for acute esophageal variceal bleeding (CHESS1905): A nationwidecohort study. Front Med (Lausanne)., 2022, 9: 872881.
[73] Vedat Goral, Nevin Yilmaz. Current approaches to the treatment of gastric varices: glue, coil application, TIPS, and BRTO. Medicina (Kaunas)., 2019;55(7): 335.
[74] Hu Z, Zhang D, Swai J, et al. Risk of rebleeding from gastroesophageal varices after initial treatment with cyanoacrylate; a systematic review and pooled analysis[J]. BMC Gastroenterol, 2020, 20(1): 181.
[75] Gillespie S-L, Mcavoy N C, Yung D E, et al. Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience[J]. J Clin Med, 2021, 10(4):
[76] Mohan B P, Chandan S, Khan S R, et al. Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis[J]. Endoscopy, 2020, 52(4): 259-267.
[77] Li B, Chen J, Zhang CQ, et al, The pharmacodynamic effect of terlipressin versus high-dose octreotide in reducing hepatic venous pressure gradient: a randomized controlled trial. Ann Transl Med, 2021;9(9): 793
[78] Louis H S Lau, Joseph J Y Sung. Treatment of upper gastrointestinal bleeding in 2020: New techniques and outcomes. Dig Endosc. 2021, 33(1): 83-94.
[79] Bridwell R E, Long B, Ramzy M, et al. Balloon Tamponade for the Management of Gastrointestinal Bleeding[J]. J Emerg Med, 2022, 62(4): 545-558.
[80] Lv Y, Yang Z, Liu L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2019, 4(8): 587-598.
[81] Kumar R, Kerbert A J C, Sheikh M F, et al. Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding[J]. J Hepatol, 2021, 74(1): 66-79.
[82] Trebicka J, Gu W, Ibáñez-Samaniego L, et al. Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS[J]. J Hepatol, 2020, 73(5): 1082-1091.
[83] Wang Z W, Liu J C, Zhao F, et al. Comparison of the effects of TIPS versus BRTO on bleeding gastric varices: A meta-analysis[J]. Can J Gastroenterol Hepatol, 2020, 2020: 5143013.
[84] Luo X, Xiang T, Wu J, et al. Endoscopic cyanoacrylate injection versus Balloon-Occluded retrograde transvenous obliteration for prevention of gastric variceal bleeding: A randomized controlled trial[J]. Hepatology (Baltimore, Md), 2021, 74(4): 2074-2084.
[85] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 12): 1087-1093.
[86] Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: Are we there yet?[J]. J Hepatol, 2020, 72(4): 774-784.
[87] 盛基尧, 刘水, 杨永生, 等. 肝硬化门静脉高压症食管胃静脉曲张出血诊疗进展[J]. 中华外科杂志, 2020, 58 (10): 808-812.
[88] Plaz Torres M C, Best L M, Freeman S C, et al. Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis[J]. Cochrane Database Syst Rev, 2021, 3: CD013122.
[89] Tian S, Li R, Guo Y, et al. Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis[J]. Ther Clin Risk Manag, 2019, 15: 191-200.
[90] Zacharias A P, Jeyaraj R, Hobolth L, et al. Carvedilol versus traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices[J]. Cochrane Database Syst Rev, 2018, 10: CD011510.
[91] Baiges A, Hernández-Gea V, Bosch J. Pharmacologic prevention of variceal bleeding and rebleeding. Hepatol Int, 2018;12(Suppl 1): 68-80..
[92] Rajapaksha IG, Gunarathne LS, Angus PW, et al. Update on new aspects of the renin-angiotensin System in hepatic fibrosis and portal hypertension: Implications for novel therapeutic options. J Clin Med. 2021;10(4): 702
[93] Shi L, Zhang X, Li J, et al. Favorableeffects of endoscopic ligation combined with drugs on rebleeding and mortality in cirrhotic patients: A Network Meta-Analysis[J]. Dig Dis, 2018, 36(2): 136-149.
[94] Yan YJ, Li Y, Fan CL, et al. A novel machine learning-based radiomic model for diagnosing high bleeding risk esophageal varices in cirrhotic patients. Hepatol Int, 2022, 16(2): 423-432.
[95] Scheiner B, Bucsics T, Bauer D, et al. The prognostic value of HVPG-response to non-selective beta-blockers in patients with NASH cirrhosis and varices. Dig Liver Dis. 2022;54(4): 500-508.
[96] Villanueva C, Albillos A, Genescà J, et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial[J]. Lancet, 2019, 393(10181): 1597-1608.
[97] Zheng JF, Zhang YN, Li P, et al. The endoscopic ultrasound probe findings in prediction of esophageal variceal recurrence after endoscopic variceal eradication therapies in cirrhotic patients: a cohort prospective study. BMC Gastroenterology. 2019, 19: 1-9.
[98] Dai C, Liu W-X, Jiang M, et al. Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: a meta-analysis[J]. World J Gastroenterol, 2015, 21(8): 2534-2541.
[99] Dunne P D J, Young D, Chuah C S, et al. Carvedilol versus endoscopic band ligation for secondary prophylaxis of variceal bleeding-Long-term follow-up of a randomised control trial[J]. Aliment Pharmacol Ther, 2022, 55(12): 1581-1587.
[100] Miao Z, Lu J, Yan J, et al. Comparison oftherapies for secondary prophylaxis of esophageal variceal bleeding in cirrhosis: A network meta-analysis of randomized controlled trials[J]. Clin Ther, 2020, 42(7): 42(7): 1246-1275.
[101] Osman KT, Nayfeh T, Abdelfattah AM, et al. Secondary prophylaxis of gastric variceal bleeding: A systematic review and network meta-analysis. Liver Transpl. 2022;28(6): 945-958.
[102] Yoo J-J, Kim S G, Kim Y S, et al. Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis[J]. Medicine (Baltimore), 2020, 99(5): e18913.
[103] Alvi H, Zuberi B F, Rasheed T, et al. Evaluation of endoscopic variceal band ligation sessions in obliteration of esophageal varices[J]. Pak J Med Sci, 2020, 36(2): 37-41.
[104] House T, Webb P, Baarson C. Massive hemorrhage from ectopic duodenal varices: importance of a multidisciplinary approach. Case Rep Gastroenterol. 2017, 11(1): 36-41.
[105] Zhan C, Prabhu V, Kang S K, et al. Comparison ofnon-tumoral portal vein thrombosis management in cirrhotic patients: TIPS versus anticoagulation versus No treatment[J]. J Clin Med, 2021, 10(11): 2316.
[106] EuropeanAssociationfortheStudyoftheLiver. EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis[J]. J Hepatol, 2022, 76(5): 1151-1184.
[107] Luo J, Li M, Wu C, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy for prevention of variceal rebleeding in patients with hepatocellular carcinoma meeting the Milan criteria[J]. Eur J Gastroenterol Hepatol, 2021, 33(3): 436-442.