Cheung J, Zeman M, van Zanten SV, Tandon P
Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from esophageal varices. [JOURNAL ARTICLE]
Aliment Pharmacol Ther 2009 Jun 25.
SUMMARY Background Variable methods are available for secondary prevention after esophageal variceal bleeding (EVB). Aim To compare band ligation (BL), pharmacotherapy (PT), and BL+PT for EVB secondary prevention. Methods A systematic search of databases, references, and meeting abstracts was conducted for randomized trials of BL, PT or BL+PT. The outcomes were mortality, rebleeding, and adverse events. A random-effects model was used for meta-analyses. Results Twelve trials were included (6 BL vs PT, 4 BL+PT vs BL, 2 BL+PT vs PT). All trials used beta-blockers +/- isosorbide mononitrate (ISMN) as PT. Mortality was not significantly different among trials. Rebleeding was not significantly different for BL vs PT (RR 1.00, 95% CI 0.73-1.37). BL reduced rebleeding compared to PT for trials with mean beta-blocker dose <80mg/d (RR 0.67, 95% CI 0.49-0.91). There were non-significant differences in rebleeding for BL+PT vs BL (RR 0.57, 95% CI 0.31-1.08) and BL+PT vs PT (RR 0.76, 95% CI 0.56-1.03). There was no difference in adverse events between BL vs PT, but was higher with BL+PT vs BL. Conclusion BL and PT alone are comparable for secondary prevention of rebleeding after EVB. Further trials with adequate PT dosing are required to determine the efficacy of combination BL+PT therapy.
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