title: Meta-analysis: beta-blockers versus banding ligation for primary prophylaxis of esophageal variceal bleeding.
abstract: OBJECTIVE
  To perform an updated meta-analysis comparing β-blockers (BB) with endoscopic variceal banding ligation (EVBL) in the primary prophylaxis of esophageal variceal bleeding.
  
  
  METHODS
  Randomized controlled trials were identified through electronic databases, article reference lists and conference proceedings. Analysis was performed using both fixed-effect and random-effect models. Heterogeneity and publication bias were systematically taken into account. Main outcomes were variceal bleeding rates and all-cause mortality, calculated overall and at 6, 12, 18 and 24 months.
  
  
  RESULTS
  19 randomized controlled trials were analyzed including a total of 1,483 patients. Overall bleeding rates were significantly lower for the EVBL group: odds ratio (OR) 2.06, 95% confidence interval (CI) [1.55-2.73], p < 0.0001, without evidence of publication bias. Bleeding rates were also significantly lower at 18 months (OR 2.20, 95% CI [1.04-4.60], P = 0.04), but publication bias was detected. When only high quality trials were taken into account, results for bleeding rates were no longer significant. No significant difference was found for either bleeding-related mortality or for all-cause mortality overall or at 6, 12, 18 or 24 months. BB were associated with more frequent severe adverse events (OR 2.61, 95% CI 1.60-4.40, P < 0.0001) whereas fatal adverse events were more frequent with EVBL (OR 0.14, 95% CI 0.02-0.99, P = 0.05).
  
  
  CONCLUSIONS
  EVBL appears to be superior to BB in preventing the first variceal bleed, although this finding may be biased as it was not confirmed by high quality trials. No difference was found for mortality. Current evidence is insufficient to recommend EVBL over BB as first-line therapy.
authors.affiliation: Department  of  Hepato-gastroenterology  B,  Hôpital  Saint  Eloi,  Centre  Hospitalier  Universitaire  de  Montpellier,  France.
authors.forename: Natalie
authors.initials: N
authors.lastname: Funakoshi
authors.forename: Yohan
authors.initials: Y
authors.lastname: Duny
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Valats
authors.forename: Frédérique
authors.initials: F
authors.lastname: Ségalas-Largey
authors.forename: Nicolas
authors.initials: N
authors.lastname: Flori
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*; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008026:Ligation; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists