Zeitschrift für Gastroenterologie
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Review Clinical Trial
Randomised controlled trials for variceal bleeding.
The variceal bleeding episode represents several days of high risk of bleeding, thus therapy should be evaluated not only in terms of immediate cessation of bleeding but also in terms of providing a bleed-free interval of a few days. As the risk of continued bleeding or very early rebleeding from varices diminishes rapidly following admission, time is an important confounding variable when comparing therapies within and between trials. Cirrhotics with better liver function are more likely to stop bleeding with simple measures than those with worse liver function. ⋯ Firstly improvement of existing therapies or new therapies. Secondly, investigation of therapies not related to bleeding, eg prophylaxis against infection, improvement in renal support. Lastly evaluation of predictive factors which may a priori determine a high risk of continued bleeding or early rebleeding thus justifying immediate sclerotherapy or surgery in a sub-group of patients.