Optimal Secondary Prophylaxis for Esophageal and Gastric Variceal Bleeding: A Network Meta-Analysis of Surgery, TIPS, and Endoscopy

1.1. Background Liver cirrhosis with gastroesophageal variceal bleeding is a major cause of morbidity and mortality worldwide. Secondary prophylaxis to prevent variceal rebleeding remains a clinical challenge. Although surgery, trans jugular intrahepatic portosystemic shunt (TIPS), and endoscopic therapy are widely used, their comparative efficacy and optimal treatment sequence remain controversial. 

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