Meta-analysis: beta-blockers versus banding ligation for primary prophylaxis of esophageal variceal bleeding
Journal Title: Annals of Hepatology - Year 2012, Vol 11, Issue 3
Abstract
Aim. To perform an updated meta-analysis comparing β-blockers (BB) with endoscopic variceal banding ligation (EVBL) in the primary prophylaxis of esophageal variceal bleeding. Material and 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 eventswere more frequent with EVBL (OR 0.14, 95% CI 0.02-0.99, P = 0.05). Conclusion. 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 and Affiliations
Natalie Funakoshi, Yohan Duny, Jean-Christophe Valats, Frédérique Ségalas-Largey, Nicolas Flori, Michael Bismuth, Jean-Pierre Daurès, Pierre Blanc
Keywords
Related Articles
- EP ID EP78150
- DOI -
- Views 120
- Downloads 0
Identification of genotype B among Hepatitis B Virus-infected patients in Hyderabad, India
Severe acute hepatitis in the dress syndrome: Report of two cases
The DRESS (drug rash, eosinophilia and systemic symptoms) syndrome, also known as DIHS (drug-induced hypersensitivity syndrome), is a severe idiosyncratic reaction to several drugs, mainly antiepileptics and antibiotics,...
Annals of Hepatology. What is next?
The effects of pegylated interferon alpha 2b on bile-duct ligation induced liver fibrosis in rats
Objective. To test the effects of peginterferon in an unrecoverable model of bile-duct ligation (BDL) induced liver fibrosis. Material and methods. Thirty-seven Wistar rats were divided into five groups: group 1, BDL + p...
High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients
Background. Patients with type 2 diabetes mellitus (T2DM) are at risk for developing end-stage liver disease due to nonalcoholic steatohepatitis (NASH), the aggressive form of non-alcoholic fatty liver disease (NAFLD)....