+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding



A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding



Hepatology 33(4): 802-807



Despite publication of several randomized trials of prophylactic variceal ligation, the effect on bleeding-related outcomes is unclear. We performed a meta-analysis of the trials, as identified by electronic database searching and cross-referencing. Both investigators independently applied inclusion and exclusion criteria, and abstracted data from each trial. Standard meta-analytic techniques were used to compute relative risks and the number needed to treat (NNT) for first variceal bleed, bleed-related mortality, and all-cause mortality. Among 601 patients in 5 homogeneous trials comparing prophylactic ligation with untreated controls, relative risks of first variceal bleed, bleed-related mortality, and all-cause mortality were 0.36 (0.26-0.50), 0.20 (0.11-0.39), and 0.55 (0.43-0.71), with respective NNTs of 4.1, 6.7, and 5.3. Among 283 subjects from 4 trials comparing ligation with beta-blocker therapy, the relative risk of first variceal bleed was 0.48 (0.24-0.96), with NNT of 13; however, there was no effect on either bleed-related mortality (relative risk [RR], 0.61; confidence interval [CI], 0.20-1.88) or all-cause mortality (RR, 0.95; CI, 0.56-1.62). In conclusion, compared with untreated controls, prophylactic ligation reduces the risks of variceal bleeding and mortality. Compared with beta-blockers, ligation reduces the risk for first variceal bleed but has no effect on mortality. Prophylactic ligation should be considered for patients with large esophageal varices who cannot tolerate beta-blockers. Subsequent research should further compare ligation and beta-blockers to determine the effect on mortality, and measure ligation's cost-effectiveness.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 010067896

Download citation: RISBibTeXText

PMID: 11283842

DOI: 10.1053/jhep.2001.23054


Related references

Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Alimentary Pharmacology and Therapeutics 21(4): 347-361, 2005

Combination of endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in the primary prophylaxis of oesophageal variceal bleeding An interim analysis. Hepatology 34(4 Pt 2): 534A, 2001

Sa1596 Efficacy and Safety of Endoscopic Variceal Ligation (EVL) for Primary and Secondary Prophylaxis of Esophageal Variceal Bleeding in an Underserved Population. Gastroenterology 150(4): S337-S338, 2016

Endoscopic variceal ligation combined with argon plasma coagulation versus ligation alone for the secondary prophylaxis of variceal bleeding: a systematic review and meta-analysis. European Journal of Gastroenterology and Hepatology 29(6): 621-628, 2017

Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. American Journal of Gastroenterology 100(4): 797-804, 2005

Factors predicting success of endoscopic variceal ligation for secondary prophylaxis of esophageal variceal bleeding. Journal of Gastroenterology and Hepatology 21(1 Pt 2): 237-241, 2006

Endoscopic variceal ligation in prophylaxis of first variceal bleeding in cirrhotic patients with high-risk esophageal varices. Gastrointestinal Endoscopy 47(2): 202-204, 1998

Endoscopic variceal ligation in prophylaxis of first variceal bleeding in cirrhotic patients with high-risk esophageal varices. Hepatology 25(6): 1346-1350, 1997

A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal varices. American Journal of Gastroenterology 95(9): 2413, 2000

S1834 Esophageal Variceal Band Ligation (Evl) Plus Beta-Blocker (Bb) Treatment in the Primary Prophylaxis of Esophageal Variceal Bleeding. Gastroenterology 136(5): A-826, 2009

Endoscopic variceal ligation vs endoscopic variceal sclerotherapy in the management of patients with advanced hepatocellular carcinoma and acute esophageal variceal bleeding. Gastroenterology. 104(4 Suppl.): A943, 1993

Combination therapy versus pharmacotherapy, endoscopic variceal ligation, or the transjugular intrahepatic portosystemic shunt alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized controlled trials. Oncotarget 8(34): 57399-57408, 2017

Endoscopic variceal ligation as primary prophylaxis for oesophageal variceal bleeding at a Malaysian tertiary hospital. Medical Journal of Malaysia 73(6): 361-364, 2019

A randomized controlled trial of endoscopic variceal band ligation for primary prophylaxis of variceal bleeding. European Journal of Gastroenterology and Hepatology 8(4): 337-342, 1996

Meta-analysis: beta-blockers versus banding ligation for primary prophylaxis of esophageal variceal bleeding. Annals of Hepatology 11(3): 369-383, 2012