Table 2 Summary of included studies

Wu 2017 [15]

Proton pump inhibitors

We enrolled only patients who received consecutive doses of acid suppression before the index endoscopy or during the index hospitalization. Patients receiving only a single dose were not included.

Patients with gastric variceal bleeding, patients with a failure to control the bleeding via emergent endoscopic treatments, patients with a history of endoscopy therapy (including sclerotherapy or ligation) less than one month prior to the index bleeding, moribund patients who died within 12 hours of enrollment (death event occurring in patients with a length of hospital stay less than 1 day), patients with a history of hepatocellular carcinoma or portal vein thrombosis found at any time before the index date, and patients with a history of gastric cancer any time before index date

The results of the current study suggest that adjuvant acid suppression prescription to patients who received endoscopic variceal ligation and vasoconstrictor therapy for bleeding esophageal varices may not change the rebleeding and mortality

Ghoz 2020 [16]

Proton pump inhibitor

We only included patients above the age of 18 years who had no documentation of prior endoscopic banding.

-

Post-EBL PPI therapy is associated with reduced risk of bleeding and death within 30 days after variceal hemorrhage in hospitalized patients.

Kim 2015 [17]

40 mg pantoprazole daily for at least 1 month from the day of hospital admission.

Patients who were diagnosed with bleeding GV and had undergone GVO using NBC at Chonnam National University Hospital (Gwangju, Korea) from January 2004 to July 2013

Patients who were diagnosed with bleeding GV and treated at other institutions before being referred to our center were excluded from the study. We also excluded isolated GV bleeding

The prophylactic use of PPIs reduces rebleeding after GVO using NBC in patients with gastric variceal hemorrhage. However, prophylactic use of PPIs does not reduce bleeding-related death.

Hidaka 2012 [18]

rabeprazole at a dose of 10 mg every morning for 2 years

Patients underwent variceal surveillance at the procedures unit of the Kitasato University East Hospital between March 2007 and September 2010.

Exclusion criteria were: (1) endoscopically confirmed existing varices 1 month after final EVL; (2) ongoing pharmacological therapy for portal hypertension with nonselective beta-blockers, nitrates, and angiotensin II type 1 receptor blockers (ARBs); (3) drinking alcohol within 3 months before the start of the study; (4) Child-Pugh score C10; (5) hepatocellular carcinoma (HCC); (6) portal thrombosis; (7) history of liver transplantation; and (8) pregnancy and allergy or past adverse reaction to PPIs.

Long-term administration of PPIs reduced the risk of treatment failure after EVL. Acid suppression therapy should also be considered as a treatment option after EVL.

Lau 2000 [19]

After endoscopic treatment, patients were randomly assigned to receive an intravenous infusion of placebo or omeprazole (Losec, Astra, Mِlndal, Sweden), given as an 80-mg bolus injection followed by a continuous infusion of 8 mg per hour for a period of 72 h.

Patients who were older than 16 years and in whom endoscopic treatment of actively bleeding ulcers or ulcers with nonbleeding visible vessels had been successful were eligible for the study

Patients in whom endoscopic treatment was unsuccessful were not enrolled and instead underwent immediate surgery.

After endoscopic treatment of bleeding peptic ulcers, a high-dose infusion of omeprazole substantially reduces the risk of recurrent bleeding.

Lin 1997 [20]

A 40 mg intravenous bolus of omeprazole was given followed by a 160 mg continuous infusion daily for 3 days. Thereafter, 20 mg of omeprazole was given orally once daily for 2 months

Patients were accepted for endoscopic therapy if a peptic ulcer with active bleeding or an NBVV was observed within 12 h of hospital admission.

Patients were excluded from the study if they were pregnant, did not give written informed consent, had bleeding tendency (platelet count <50×10⁹/L, serum prothrombin<30% of normal, or were taking anticoagulants

The use of omeprazole is more effective than cimetidine in increasing intragastric PH and reducing rebleeding episodes in patients with bleeding peptic ulcer after successful endoscopic therapy.

Kang 2016 [21]

PPIs were initiated once a day at standard doses

Patients with liver cirrhosis who received elective EVL for primary prophylaxis of variceal bleeding between January 1998 and April 2011 at a tertiary hospital were included

Patients excluded if underwent emergency endoscopy for acute variceal bleeding, received EVL for secondary prophylaxis of variceal bleeding, underwent EVL for nonvariceal upper gastrointestinal bleeding such as Mallory-Weiss tearing, had hepatocellular carcinoma with portal vein thrombosis, had an allergic reaction to PPIs, had active peptic ulcers, or had a gastric varix only

We suggest that PPI therapy needs to be considered in patients receiving prophylactic EVL to reduce the risk of bleeding after prophylactic EVL.