title: Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: a meta-analysis.
abstract: OBJECTIVE
  To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding.
  
  
  METHODS
  Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identified. Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account.
  
  
  RESULTS
  Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment significantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% confidence interval (CI): 1.69-2.85, P < 0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was significantly lower for the combined treatment group (OR: 1.83, 95% CI: 1.16-2.90, P = 0.009), as well as overall mortality (OR: 1.43, 95% CI: 1.03-1.98, P = 0.03).
  
  
  CONCLUSIONS
  Combination therapy should thus be recommended as the first line treatment for secondary prophylaxis of oesophageal variceal bleeding.
authors.affiliation: Department of Hepato-gastroenterology B, Saint Eloi Hospital, University Hospital of Montpellier, 80 rue Augustin Fliche, 34295 Montpellier Cedex 5, France.
authors.forename: Natalie
authors.initials: N
authors.lastname: Funakoshi
authors.forename: Frédérique
authors.initials: F
authors.lastname: Ségalas-Largey
authors.forename: Yohan
authors.initials: Y
authors.lastname: Duny
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Valats
authors.forename: Michael
authors.initials: M
authors.lastname: Bismuth
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daurès
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000473:pathology* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D015911:Sclerotherapy; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists