Combination endoscopic band ligation and sclerotherapy compared with endoscopic band ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage: a meta-analysis.
Endoscopic band ligation (EBL) is the community-accepted standard therapy for the secondary prophylaxis of esophageal variceal hemorrhage. Recent data indicate that combination EBL and sclerotherapy may be a more effective therapy than EBL alone. Yet existing data are conflicting. We therefore performed a meta-analysis to compare the efficacy and safety of EBL and sclerotherapy versus EBL alone for the secondary prophylaxis of esophageal variceal hemorrhage. We performed a systematic review of two computerized databases (MEDLINE and EMBASE) along with manual-searching of published abstracts to identify relevant citations without language restrictions from 1990 to 2002. Eight studies met explicit inclusion criteria. We performed meta-analysis of these studies to pool the relative risk for the following outcomes: esophageal variceal rebleeding, death, number of endoscopic sessions to achieve variceal obliteration, and therapeutic complications. There were no significant differences between EBL and sclerotherapy versus EBL alone in the risk of esophageal variceal rebleeding (RR = 1.05; 95% CI = 0.67-1.64; P = 0.83), death (RR = 0.99; 95% CI = 0.68-1.44; P = 0.96), or number of endoscopic sessions to variceal obliteration (RR = 0.23; 95% CI = 0.055-0.51; P = 0.11). However, the incidence of esophageal stricture formation was significantly higher in the EBL group than in the sclerotherapy group. There is no evidence that the addition of sclerotherapy to endoscopic band ligation changes clinically relevant outcomes (variceal rebleeding, death, time to variceal obliteration) in the secondary prophylaxis of esophageal variceal hemorrhage. Moreover, combination EBL and sclerotherapy had more esophageal stricture formation than EBL alone.
Karsan
Hetal A
HA
VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Center for the Health Sciences, Division of Digestive Diseases, Los Angeles, California 90073, USA.
Morton
Sally C
SC
Shekelle
Paul G
PG
Spiegel
Brennan M R
BM
Suttorp
Marika J
MJ
Edelstein
Marc A
MA
Gralnek
Ian M
IM
D004932:Esophageal and Gastric Varices / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008026:Ligation; D016032:Randomized Controlled Trials as Topic; D015911:Sclerotherapy; D016896:Treatment Outcome
Gastrointest Endosc. 2000 Feb;51(2):157-63
10650257
N Engl J Med. 2001 Aug 30;345(9):669-81
11547722
BMJ. 1994 Nov 12;309(6964):1286-91
7718048
Biometrics. 1994 Dec;50(4):1088-101
7786990
Ann Intern Med. 1995 Aug 15;123(4):280-7
7611595
Hepatology. 1998 Aug;28(2):391-5
9696002
Control Clin Trials. 1986 Sep;7(3):177-88
3802833
N Engl J Med. 1988 Oct 13;319(15):983-9
3262200
Gastroenterology. 1996 Feb;110(2):529-33
8566601
Gastrointest Endosc. 1999 Jul;50(1):1-6
10385713
Am J Gastroenterol. 2002 Mar;97(3):623-9
11922557
Hepatology. 1999 Jan;29(1):44-50
9862848
Hepatology. 1997 Jan;25(1):71-4
8985267
Endoscopy. 1999 May;31(4):286-90
10376453
Am J Gastroenterol. 1997 Jun;92(6):950-3
9177508
Control Clin Trials. 1996 Feb;17(1):1-12
8721797
Gastrointest Endosc. 2001 May;53(6):572-8
11323581
BMJ. 1997 Sep 13;315(7109):629-34
9310563
Eur J Gastroenterol Hepatol. 2001 Jan;13(1):81-8
11204818
Gastroenterology. 1981 Apr;80(4):800-9
6970703