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Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices Cheung J; Zeman M; van Zanten SV; Tandon PAliment Pharmacol Ther 2009[Sep]; 30 (6): 577-88BACKGROUND: 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.|*Secondary Prevention[MESH]|Adrenergic beta-Antagonists/*therapeutic use[MESH]|Combined Modality Therapy/methods[MESH]|Esophageal and Gastric Varices/*drug therapy[MESH]|Gastrointestinal Hemorrhage/*drug therapy[MESH]|Humans[MESH]|Isosorbide Dinitrate/*analogs & derivatives/therapeutic use[MESH]|Ligation[MESH]|Randomized Controlled Trials as Topic[MESH]|Treatment Outcome[MESH]|Vasodilator Agents[MESH] |
