Jacob Korula, MD, FRCPC, FACP
In patients with esophageal varices and no previous bleeding, how do primary prophylaxis with banding ligation (BL) and β-blockers compare?
MEDLINE, EMBASE/Excerpta Medica, Cochrane Hepato-Biliary Group Controlled Trials Register, and Science Citation Index Expanded (all to March 2007); Cochrane Library (Issue 1, 2007); reference lists; conference proceedings; experts; and pharmaceutical companies.
Randomized controlled trials (RCTs) comparing BL with any β-blocker in patients with esophageal varices and no previous bleeding. 16 RCTs (n = 1167, mean age range 39 to 62 y) met the selection criteria; 3 RCTs had adequate control of bias. In the included trials, BL was performed with conventional or multiband ligators under benzodiazepine sedation at 3- to 4-week intervals until eradication of varices; β-blockers were propanolol or nadolol at an initial dosage of 40 to 80 mg/d, then titrated to reduce heart rate by 20% to 25% or < 60 beats/min.
All-cause mortality. Secondary outcomes included bleeding-related mortality, upper gastrointestinal (GI) bleeding (variceal or nonvariceal), and variceal bleeding.
BL and β-blockers did not differ for all-cause mortality or bleeding-related mortality (Table). In 3 RCTs with adequate bias control, groups did not differ for upper GI bleeding or variceal bleeding; in RCTs with unclear bias control, BL reduced upper GI bleeding (13 RCTs) and variceal bleeding (11 RCTs) more than did β-blockers (Table).
Primary prophylaxis with banding ligation and β-blockers do not differ for all-cause mortality or bleeding-related mortality in patients with esophageal varices and no previous bleeding.
Primary prophylaxis with banding ligation (BL) vs β-blockers in patients with esophageal varices and no previous bleeding*
*GI = gastrointestinal; other abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from control event rates and relative risks provided by author. Analysis based on a random-effects model.
Korula J. Review: Primary prophylaxis with banding ligation or β-blockers does not differ for mortality in esophageal varices. Ann Intern Med. 2008;148:JC3–10. doi: 10.7326/0003-4819-148-10-200805200-02010
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Published: Ann Intern Med. 2008;148(10):JC3-10.
Esophageal Disorders, Gastroenterology/Hepatology, Liver Disease.
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