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Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: a meta-analysis Li L; Yu C; Li YCan J Gastroenterol 2011[Mar]; 25 (3): 147-55OBJECTIVE: To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the efficacy of endoscopic band ligation (EBL) versus pharmacological therapy for the primary and secondary prophylaxis of variceal hemorrhage in patients with cirrhosis. METHODS: Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases. Eighteen randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis. RESULTS: Among 1023 patients in 12 trials comparing EBL with beta-blockers for primary prevention, there was no significant difference in gastrointestinal bleeding (RR 0.79 [95% CI 0.61 to 1.02]), all-cause deaths (RR 1.06 [95% CI 0.86 to 1.30]) or bleeding-related deaths (RR 0.66 [95% CI 0.38 to 1.16]). There was a reduced trend toward significance in variceal bleeding with EBL compared with betablockers (RR 0.72 [95% CI 0.54 to 0.96]). However, variceal bleeding was not significantly different between the two groups in high-quality trials (RR 0.84 [95% CI 0.60 to 1.17]). Among 687 patients from six trials comparing EBL with beta-blockers plus isosorbide mononitrate for secondary prevention, there was no effect on either gastrointestinal bleeding (RR 0.95 [95% CI 0.65 to 1.40]) or variceal bleeding (RR 0.89 [95% CI 0.53 to 1.49]). The risk for all-cause deaths in the EBL group was significantly higher than in the medical group (RR 1.25 [95% CI 1.01 to 1.55]); however, the rate of bleeding related deaths was unaffected (RR 1.16 [95% CI 0.68 to 1.97]). CONCLUSIONS: Both EBL and beta-blockers may be considered first-line treatments to prevent first variceal bleeding, whereas betablockers plus isosorbide mononitrate may be the best choice for the prevention of rebleeding.|*Adrenergic beta-Antagonists/therapeutic use[MESH]|Comparative Effectiveness Research[MESH]|Endoscopy/methods[MESH]|Esophageal and Gastric Varices/*complications/physiopathology/*prevention & control[MESH]|Gastrointestinal Hemorrhage/*etiology/mortality/physiopathology/*therapy[MESH]|Humans[MESH]|Isosorbide Dinitrate/*analogs & derivatives/therapeutic use[MESH]|Ligation/*adverse effects[MESH]|Liver Cirrhosis/*complications/physiopathology[MESH]|Primary Prevention[MESH]|Randomized Controlled Trials as Topic[MESH]|Risk Factors[MESH]|Secondary Prevention[MESH]|Treatment Outcome[MESH]|Vasodilator Agents/therapeutic use[MESH] |
