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Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding.
Aliment Pharmacol Ther. 2005 Feb 15; 21(4):347-61.AP

Abstract

BACKGROUND

The treatment effects of primary prophylactic endoscopic variceal ligation are unclear.

AIM

To compare the treatment effects of endoscopic variceal ligation and beta-blockers for primary prophylaxis of oesophageal variceal bleeding. In addition, a subgroup analysis was done with the purpose to delineate differences in the effects of intervention that were biologically based.

METHODS

We performed a literature search for randomized controlled trials, which compared the treatment effects of endoscopic variceal ligation with beta-blockers for primary prophylaxis of oesophageal variceal bleeding. Of the 955 articles screened, eight randomized-controlled trials including 596 subjects (285 with endoscopic variceal ligation and 311 with beta-blockers) were analysed. Outcomes measures evaluated were first gastrointestinal bleed, first variceal bleed, all-cause deaths, bleed-related deaths and severe adverse events. The measure of association employed was relative risk; with heterogeneity and sensitivity analyses.

RESULTS

Variceal obliteration was obtained in 261 (91.6%) patients and target beta-blockers therapy was achieved in 294 (94.5%) patients (P = 0.19). Endoscopic variceal ligation compared with beta-blockers significantly reduced rates of first gastrointestinal bleed by 31% (RR, 0.69; 95% CI: 0.49-0.96; P = 0.03; NNTB = 15) and first variceal bleed by 43% (RR, 0.57; 95% CI: 0.38-0.85; P = 0.0067; NNTB = 11). All-cause deaths and bleed-related deaths were unaffected (RR, 1.03; 95% CI: 0.79-1.36; P = 0.81 and RR, 0.84; 95% CI: 0.44-1.61; P = 0.60 respectively). Severe adverse events were significantly less in endoscopic variceal ligation compared with beta-blockers (RR, 0.34; 95% CI: 0.17-0.69; P = 0.0024; NNTB = 28). Sensitivity analysis of five trials published in peer review journals and four trials with high quality showed results similar to those seen in the primary analysis of all the eight trials, confirming stability of conclusions. Following variceal obliteration with endoscopic variceal ligation, oesophageal varices recurred in 83 (29.1%) patients. Seven (28.1%) patients bled with one fatal outcome. In subgroup analyses, endoscopic variceal ligation had significant advantage compared wtih beta-blockers in trials including < or =30% patients with alcoholic cirrhosis, >30% patients with Child Class C cirrhosis and >50% patients with large varices.

CONCLUSIONS

In patients with cirrhosis with moderate to large varices and who have not bled, endoscopic varices ligation compared with beta-blockers significantly reduced bleeding episodes and severe adverse events, but had no effect on mortality.

Authors+Show Affiliations

Khuroo MS
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. khuroo@yahoo.com
Khuroo NS
No affiliation info available
Farahat KL
No affiliation info available
Khuroo YS
No affiliation info available
Sofi AA
No affiliation info available
Dahab ST
No affiliation info available

MeSH

Adrenergic beta-AntagonistsEsophageal and Gastric VaricesEsophagoscopyGastrointestinal HemorrhageHumansLigationRandomized Controlled Trials as Topic

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

15709985

Citation

Khuroo, M S., et al. "Meta-analysis: Endoscopic Variceal Ligation for Primary Prophylaxis of Oesophageal Variceal Bleeding." Alimentary Pharmacology & Therapeutics, vol. 21, no. 4, 2005, pp. 347-61.
Khuroo MS, Khuroo NS, Farahat KL, et al. Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther. 2005;21(4):347-61.
Khuroo, M. S., Khuroo, N. S., Farahat, K. L., Khuroo, Y. S., Sofi, A. A., & Dahab, S. T. (2005). Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Alimentary Pharmacology & Therapeutics, 21(4), 347-61.
Khuroo MS, et al. Meta-analysis: Endoscopic Variceal Ligation for Primary Prophylaxis of Oesophageal Variceal Bleeding. Aliment Pharmacol Ther. 2005 Feb 15;21(4):347-61. PubMed PMID: 15709985.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. AU - Khuroo,M S, AU - Khuroo,N S, AU - Farahat,K L C, AU - Khuroo,Y S, AU - Sofi,A A, AU - Dahab,S T, PY - 2005/2/16/pubmed PY - 2005/5/25/medline PY - 2005/2/16/entrez SP - 347 EP - 61 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 21 IS - 4 N2 - BACKGROUND: The treatment effects of primary prophylactic endoscopic variceal ligation are unclear. AIM: To compare the treatment effects of endoscopic variceal ligation and beta-blockers for primary prophylaxis of oesophageal variceal bleeding. In addition, a subgroup analysis was done with the purpose to delineate differences in the effects of intervention that were biologically based. METHODS: We performed a literature search for randomized controlled trials, which compared the treatment effects of endoscopic variceal ligation with beta-blockers for primary prophylaxis of oesophageal variceal bleeding. Of the 955 articles screened, eight randomized-controlled trials including 596 subjects (285 with endoscopic variceal ligation and 311 with beta-blockers) were analysed. Outcomes measures evaluated were first gastrointestinal bleed, first variceal bleed, all-cause deaths, bleed-related deaths and severe adverse events. The measure of association employed was relative risk; with heterogeneity and sensitivity analyses. RESULTS: Variceal obliteration was obtained in 261 (91.6%) patients and target beta-blockers therapy was achieved in 294 (94.5%) patients (P = 0.19). Endoscopic variceal ligation compared with beta-blockers significantly reduced rates of first gastrointestinal bleed by 31% (RR, 0.69; 95% CI: 0.49-0.96; P = 0.03; NNTB = 15) and first variceal bleed by 43% (RR, 0.57; 95% CI: 0.38-0.85; P = 0.0067; NNTB = 11). All-cause deaths and bleed-related deaths were unaffected (RR, 1.03; 95% CI: 0.79-1.36; P = 0.81 and RR, 0.84; 95% CI: 0.44-1.61; P = 0.60 respectively). Severe adverse events were significantly less in endoscopic variceal ligation compared with beta-blockers (RR, 0.34; 95% CI: 0.17-0.69; P = 0.0024; NNTB = 28). Sensitivity analysis of five trials published in peer review journals and four trials with high quality showed results similar to those seen in the primary analysis of all the eight trials, confirming stability of conclusions. Following variceal obliteration with endoscopic variceal ligation, oesophageal varices recurred in 83 (29.1%) patients. Seven (28.1%) patients bled with one fatal outcome. In subgroup analyses, endoscopic variceal ligation had significant advantage compared wtih beta-blockers in trials including < or =30% patients with alcoholic cirrhosis, >30% patients with Child Class C cirrhosis and >50% patients with large varices. CONCLUSIONS: In patients with cirrhosis with moderate to large varices and who have not bled, endoscopic varices ligation compared with beta-blockers significantly reduced bleeding episodes and severe adverse events, but had no effect on mortality. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/15709985/Meta_analysis:_endoscopic_variceal_ligation_for_primary_prophylaxis_of_oesophageal_variceal_bleeding_ DB - PRIME DP - Unbound Medicine ER -