1.1 Evidence supports the case for adopting Danis stent for treating acute oesophageal variceal bleeding. Danis stent improves the short-term control of bleeding compared with a balloon tamponade and can be left in place for longer, allowing time for stabilisation.
1.2 Danis stent should be considered for people aged 16 and over with acute oesophageal variceal bleeding that does not respond to endoluminal therapy and whose oesophageal varices are being considered for definitive treatment. Also, Danis stent should be considered for people when definitive treatment is not appropriate and if they are likely to be offered palliative care.
1.3 Cost modelling shows that Danis stent is cost saving compared with balloon tamponade for acute oesophageal variceal bleeding being considered for definitive treatment. This is because having Danis stent results in a shorter stay in intensive care. To be cost saving, Danis stent needs to decrease intensive care stay by approximately 1 day or more compared with balloon tamponade. For more details, see the NICE resource impact report.
Why the committee made these recommendations
Danis stent puts pressure on enlarged veins (varices) in a person's food pipe (oesophagus) when they are bleeding uncontrollably. Enlarged veins can develop when a person has longstanding scarring liver disease (cirrhosis) that affects blood flow through the liver. This causes pressure in the blood vessel that drains blood from the gut into the liver and enlargement of these veins in the oesophagus can predispose to bleeding. Danis stent is designed to be used as a bridging treatment to control the bleeding until a decision on definitive treatment to manage the underlying pressure problem (such as a transjugular intrahepatic portosystemic shunt [TIPS] procedure, or band ligation) can be made. It can also be used for people when definitive treatment is not appropriate and if they are likely to be offered palliative care.
Studies show that Danis stent is better than the balloon tamponade device (a balloon inflation device that compresses the bleeding veins) in controlling bleeding in the short term. It can stay in place for up to 7 days. This is longer than the balloon tamponade, which needs to be removed after 24 hours. This allows more time to stabilise the person before their next treatment and also means that they do not usually need to stay in intensive care. Cost analysis concludes that Danis stent is cost saving compared with balloon tamponade because it reduces the number of days a person needs to stay in intensive care.