As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr. Y. Yuan.
Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices
Version of Record online: 26 MAR 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 10, pages 1155–1165, May 2012
How to Cite
Thiele, M., Krag, A., Rohde, U. and Gluud, L. L. (2012), Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices. Alimentary Pharmacology & Therapeutics, 35: 1155–1165. doi: 10.1111/j.1365-2036.2012.05074.x
- Issue online: 15 APR 2012
- Version of Record online: 26 MAR 2012
- Manuscript Accepted: 5 MAR 2012
- Manuscript Revised: 1 MAR 2012
- Manuscript Revised: 24 JAN 2012
- Manuscript Received: 31 DEC 2011
In patients with oesophageal varices, the combination of endoscopic variceal ligation (EVL) and medical therapy is recommended as standard of care for prevention of rebleeding. The results of previous meta-analyses on this topic are equivocal.
To assess the effects of EVL plus medical therapy vs. monotherapy (EVL or medical therapy alone) for secondary prevention in oesophageal varices.
Electronic and manual searches were combined. The primary outcome measures were overall rebleeding (variceal and nonvariceal) and mortality. Random-effects meta-analyses were performed with subgroup, sensitivity, regression and sequential analyses to identify sources of intertrial heterogeneity and the robustness of the results.
Nine randomised trials were included. In total, 442 patients were randomised to combination therapy and 513 to monotherapy. Combination therapy reduced rebleeding (RR = 0.68; 95% CI = 0.54–0.85; number needed to treat eight patients). The result was confirmed in sequential and regression analyses, but not when limiting the analysis to trials with adequate selection bias control. No effect on overall mortality was identified (RR = 0.89; 95% CI = 0.65–1.21). Combination therapy reduced bleeding-related mortality (RR = 0.52; 95% CI 0.27–0.99; number needed to treat 33 patients) and the risk of rebleeding from oesophageal varices. Combination therapy increased the risk of serious adverse events in fixed, but not in random-effects meta-analyses.
The combination of endoscopic variceal ligation and medical therapy reduce the risk of rebleeding, but not overall mortality. Additional research is needed to determine why reduced rebleeding rates do not lead to reduced mortality.