Role of endoscopic variceal sclerotherapy in the long-term management of variceal bleeding: a meta-analysis.
Seven randomized clinical trials evaluating the effect of repeated endoscopic variceal sclerotherapy on the long-term survival of patients with variceal hemorrhage have been published in the English-language literature. In four trials, the sclerotherapy-treated patients showed an improved long-term survival (follow-up periods longer than a year) when compared with patients in the medical regimen group, whereas in the other three trials, the long-term survival did not differ between the compared groups. Sample sizes in these "negative" trials were too small to detect a true moderate effect for serial sclerotherapy. To resolve this controversy, we combined the findings from all trials using a meta-analysis and determined the overall effect of repeated endoscopic variceal sclerotherapy on the survival of patients who had previously bled from esophageal varices. An overall risk difference of -0.15 (95% confidence limits, -0.21 to -0.08; p less than 0.0005) was estimated, indicating that sclerotherapy reduced the number of deaths by 25%. The estimated overall risk difference remained negative even when all patients in the sclerotherapy group with an unknown survival status were pessimistically considered dead at the end of the follow-up period. The results of this quantitative synthesis suggest that patients with bleeding esophageal varices benefit from the inclusion of repeated sclerotherapy in their long-term management regimen.
Infante-Rivard
C
C
School of Occupational Health, McGill University, Montreal, Canada.
Esnaola
S
S
Villeneuve
J P
JP
D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D012306:Risk; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors
D012597:Sclerosing Solutions