title: Variceal band ligation versus beta-blockers for primary prevention of variceal bleeding: a meta-analysis.
abstract: OBJECTIVE
  Variceal band ligation (VBL) can reduce the rate of the first variceal by 45-52% compared with beta-blockers (BBs). We performed an updated meta-analysis of nine randomized controlled trials published as full papers, comparing VBL with BB for primary prevention.
  
  
  METHODS
  Relative risk (RR) was computed using a random effects model. Sensitivity analysis was performed using a fixed effects model. Publication bias was also assessed using funnel plots and the rank correlation test.
  
  
  RESULTS
  In total, 734 patients were studied (356, VBL; 378, BB). The pooled RR favoured VBL for first variceal bleed [0.63; 95% confidence interval (CI), 0.43-0.92] with number needed to treat being 13 (95% CI, 7-33), and for adverse events resulting in treatment withdrawal (0.24; 95% CI, 0.12-0.47) with the corresponding number needed to treat being 10 (95% CI, 6-25). Banding-related bleeding occurred in six patients (fatal in two). No difference was seen in bleeding-related deaths (RR, 0.71; 95% CI, 0.38-1.32), or overall mortality (RR, 1.09; 95% CI, 0.86-1.38). No significant heterogeneity or publication bias was present, and outcomes remained robust after sensitivity analyses.
  
  
  CONCLUSIONS
  VBL was superior to BB in preventing the first variceal bleed, with fewer adverse events resulting in treatment discontinuation. Careful attention to technique and patient selection are important to minimize iatrogenic complications with VBL. VBL has a role in patients with poor drug compliance, or tolerance, and in those who bleed on BB therapy.
authors.affiliation: Department of Hepatology, Royal Infirmary of Edinburgh, Wellcome Trust Clinical Research Facility, Western General Hospital, Edinburgh, UK. tdrdhir@aol.com
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Tripathi
authors.forename: Catriona
authors.initials: C
authors.lastname: Graham
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hayes
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists