[Sclerotherapy versus ligation in hemorrhage caused by rupture of esophageal varices. Direct meta-analysis of randomized trials].
OBJECTIVE
To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included.


METHODS
The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review.


RESULTS
Endoscopic sclerotherapy compared to banding ligation significantly increased the rate of rebleeding (OR: 1.6; 95% IC: 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR: 1.3; 95% IC: 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR: 0.9; 95% IC: 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR: 2.5; 95% IC: 1.7-3.7), in those cases with a positive heterogeneity test.


CONCLUSIONS
This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.
Heresbach
D
D
Service d'Hépato-Gastroentérologie, CHRU Pontchaillou, Rennes.
Jacquelinet
C
C
Nouel
O
O
Chaperon
J
J
Bretagne
J F
JF
Gosselin
M
M
D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008026:Ligation; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D011183:Postoperative Complications; D012008:Recurrence; D012422:Rupture, Spontaneous; D015911:Sclerotherapy / Q000379:methods*
Sclérothérapie versus ligature au cours de l'hémorragie par rupture de varices oesophagiennes. Méta-analyse directe des essais randomisés.