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Benefit of combination beta-blocker and endoscopic treatment to prevent variceal rebleeding: a meta-analysis Funakoshi N; Segalas-Largey F; Duny Y; Oberti F; Valats JC; Bismuth M; Daures JP; Blanc PWorld J Gastroenterol 2010[Dec]; 16 (47): 5982-92AIM: To determine whether the association of beta-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus beta-blockers (BB) or banding ligation (BL) with BL plus BB were identified. Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination beta-blocker and endoscopic treatment significantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% confidence interval (CI): 1.69-2.85, P < 0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was significantly lower for the combined treatment group (OR: 1.83, 95% CI: 1.16-2.90, P = 0.009), as well as overall mortality (OR: 1.43, 95% CI: 1.03-1.98, P = 0.03). CONCLUSION: Combination therapy should thus be recommended as the first line treatment for secondary prophylaxis of oesophageal variceal bleeding.|*Secondary Prevention[MESH]|Adrenergic beta-Antagonists/*therapeutic use[MESH]|Adult[MESH]|Endoscopy/*methods[MESH]|Esophageal and Gastric Varices/*pathology/therapy[MESH]|Gastrointestinal Hemorrhage/*prevention & control/*therapy[MESH]|Humans[MESH]|Ligation[MESH]|Male[MESH]|Middle Aged[MESH]|Randomized Controlled Trials as Topic[MESH]|Sclerotherapy[MESH]|Treatment Outcome[MESH] |
