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Aliment Pharmacol Ther. 2009 Sep 15;30(6):577-88. doi: 10.1111/j.1365-2036.2009.04075.x. Epub 2009 Jun 25.

Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices.

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1
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada. justin.cheung@ualberta.ca

Abstract

BACKGROUND:

Variable methods are available for secondary prevention after oesophageal 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 with PT for trials with mean beta-blocker dose <80 mg/day (RR 0.67, 95% CI 0.49-0.91). There were nonsignificant 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:

Band ligation 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.

[Indexed for MEDLINE]
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