title: Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices.
abstract: BACKGROUND
  Variable methods are available for secondary prevention after oesophageal variceal bleeding (EVB).
  
  
  OBJECTIVE
  To compare band ligation (BL), pharmacotherapy (PT) and BL+PT for EVB secondary prevention.
  
  
  METHODS
  A systematic search of databases, references and meeting abstracts was conducted for randomized trials of BL, PT or BL+PT. The outcomes were mortality, rebleeding and adverse events. A random-effects model was used for meta-analyses.
  
  
  RESULTS
  Twelve trials were included (6 BL vs. PT, 4 BL+PT vs. BL, 2 BL+PT vs. PT). All trials used beta-blockers +/- isosorbide mononitrate (ISMN) as PT. Mortality was not significantly different among trials. Rebleeding was not significantly different for BL vs. PT (RR 1.00, 95% CI 0.73-1.37). BL reduced rebleeding compared with PT for trials with mean beta-blocker dose <80 mg/day (RR 0.67, 95% CI 0.49-0.91). There were nonsignificant differences in rebleeding for BL+PT vs. BL (RR 0.57, 95% CI 0.31-1.08) and BL+PT vs. PT (RR 0.76, 95% CI 0.56-1.03). There was no difference in adverse events between BL vs. PT, but was higher with BL+PT vs. BL.
  
  
  CONCLUSIONS
  Band ligation and PT alone are comparable for secondary prevention of rebleeding after EVB. Further trials with adequate PT dosing are required to determine the efficacy of combination BL+PT therapy.
authors: Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada. justin.cheung@ualberta.ca
authors: J
authors: J
authors: Cheung
authors: M
authors: M
authors: Zeman
authors: S V
authors: SV
authors: van Zanten
authors: P
authors: P
authors: Tandon
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008026:Ligation; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate