Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: a meta-analysis.

Abstract

OBJECTIVE:

To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the efficacy of endoscopic band ligation (EBL) versus pharmacological therapy for the primary and secondary prophylaxis of variceal hemorrhage in patients with cirrhosis.

METHODS:

Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases. Eighteen randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis.

RESULTS:

Among 1023 patients in 12 trials comparing EBL with beta-blockers for primary prevention, there was no significant difference in gastrointestinal bleeding (RR 0.79 [95% CI 0.61 to 1.02]), all-cause deaths (RR 1.06 [95% CI 0.86 to 1.30]) or bleeding-related deaths (RR 0.66 [95% CI 0.38 to 1.16]). There was a reduced trend toward significance in variceal bleeding with EBL compared with betablockers (RR 0.72 [95% CI 0.54 to 0.96]). However, variceal bleeding was not significantly different between the two groups in high-quality trials (RR 0.84 [95% CI 0.60 to 1.17]). Among 687 patients from six trials comparing EBL with beta-blockers plus isosorbide mononitrate for secondary prevention, there was no effect on either gastrointestinal bleeding (RR 0.95 [95% CI 0.65 to 1.40]) or variceal bleeding (RR 0.89 [95% CI 0.53 to 1.49]). The risk for all-cause deaths in the EBL group was significantly higher than in the medical group (RR 1.25 [95% CI 1.01 to 1.55]); however, the rate of bleeding related deaths was unaffected (RR 1.16 [95% CI 0.68 to 1.97]).

CONCLUSIONS:

Both EBL and beta-blockers may be considered first-line treatments to prevent first variceal bleeding, whereas betablockers plus isosorbide mononitrate may be the best choice for the prevention of rebleeding.

• Authors: Lan Li, Chaohui Yu, Youming Li
• Journal: Canadian journal of gastroenterology = Journal canadien de gastroenterologie (Can J Gastroenterol) Vol. 25 Issue 3 Pg. 147-55 (Mar 2011) ISSN: 0835-7900 [Print] Canada
• PMID: 21499579 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Adrenergic beta-Antagonists
• Vasodilator Agents
• Isosorbide Dinitrate
• isosorbide-5-mononitrate

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Comparative Effectiveness Research
• Endoscopy (methods)
• Esophageal and Gastric Varices (complications, physiopathology, prevention & control)
• Gastrointestinal Hemorrhage (etiology, mortality, physiopathology, therapy)
• Humans
• Isosorbide Dinitrate (analogs & derivatives, therapeutic use)
• Ligation (adverse effects)
• Liver Cirrhosis (complications, physiopathology)
• Primary Prevention
• Randomized Controlled Trials as Topic
• Risk Factors
• Secondary Prevention
• Treatment Outcome
• Vasodilator Agents (therapeutic use)