Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from esophageal varices. Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] Journal article

Title	Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from esophageal varices.
Author(s)	Cheung J, Zeman M, van Zanten SV, Tandon P
Institution	Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada; Capital Health, Edmonton, Canada.
Source	Aliment Pharmacol Ther 2009 Jun 25.
Abstract	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.
Language	ENG
Pub Type(s)	JOURNAL ARTICLE
PubMed ID	19558563

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