TITLE

Banding Ligation Versus Beta-Blockers as Primary Prophylaxis in Esophageal Varices: Systematic Review of Randomized Trials

AUTHOR(S)
Gluud, Lise L.; Klingenberg, Sarah; Nikolova, Dimitrinka; Gluud, Christian
PUB. DATE
December 2007
SOURCE
American Journal of Gastroenterology;Dec2007, Vol. 102 Issue 12, p2842
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding. METHODS: Randomized trials were identified through electronic databases, reference lists in relevant articles, and correspondence with experts. Three authors extracted data. Random effects meta-analysis and metaregression were performed. The reported allocation sequence generation and concealment were extracted as measures of bias control. RESULTS: The initial searches identified 1,174 references. Sixteen trials were included. In 15 trials, patients had high-risk varices. Three trials reported adequate bias control. All trials reported mortality for banding ligation (116/573 patients) and beta-blockers (115/594 patients). Mortality in the two treatment groups was not significantly different in the trials with adequate bias control (relative risk 1.22, 95% CI 0.84–1.78) or unclear bias control (RR 1.02, 95% CI 0.75–1.39). Trials with adequate bias control found no significant difference in bleeding rates (RR 0.86, 95% CI 0.55–1.35). Trials with unclear bias control found that banding ligation significantly reduced bleeding (RR 0.56, 95% CI 0.41–0.77). Both treatments were associated with adverse events. In metaregression analyses, the estimated effect of ligation was significantly more positive if trials were published as abstracts. Likewise, the shorter the follow-up, the more positive the estimated effect of ligation. CONCLUSIONS: Banding ligation and beta-blockers may be used as primary prophylaxis in high-risk esophageal varices. The estimated effect of banding ligation in some trials may be biased and was associated with the duration of follow-up. Further high-quality trials are still needed.
ACCESSION #
27609286

 

Related Articles

  • Management of Patients with Incidental Esophageal Varices. Sadovsky, Richard // American Family Physician;3/1/2005, Vol. 71 Issue 5, p980 

    Discusses research being done on the management of incidental esophageal varices and the risk of rupture with increasing wall tension. Reference to a study by R De Franchis published in a June 2004 issue of "Gastroenterology"; Indication of the presence of esophageal varices in patients with...

  • Measuring the hemodynamic response to primary pharmacoprophylaxis of variceal bleeding: a cost-effectiveness analysis. Imperiale, Thomas F.; Chalasani, Naga; Klein, Robert W. // American Journal of Gastroenterology;Dec2003, Vol. 98 Issue 12, p2742 

    OBJECTIVES: The hemodynamic response to β-blockers alone or with nitrates is highly predictive of efficacy in prevention of variceal bleeding. Hemodynamic monitoring (HDM) requires catheterization of the hepatic vein and measurement of the hepatic venous pressure gradient, the difference...

  • Pro: Cirrhotic Patients With Small Esophageal Varices Should Undergo Primary Prophylaxis. Giannini, Edoardo G. // American Journal of Gastroenterology;Sep2009, Vol. 104 Issue 9, p2132 

    The article focuses on the issue concerning the risk of prophylactic intervention to patients suffering from liver cirrhosis with small esophageal varices. It cites that primary prophylaxis with beta-blockers is ideal in preventing high risk of bleeding in patients with small varices. It also...

  • Continuing Medical Education: December 2007.  // American Journal of Gastroenterology;Dec2007, Vol. 102 Issue 12, p2841 

    Banding Ligation Versus Beta-BLockers as Primary Prophylaxis in Esophageal Varices: Systematic Review of Randomized Trials Accreditation and Designation Statement: Blackwell Futura Media Services designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician's...

  • VARICEAL BLEEDING AND βBLOCKADE: PERMUTATION ON THE THEME? Pfeffer, Robert; Reinus, John F.; Cattau Jr., Edward L.; Johnson, David A. // American Journal of Gastroenterology;Dec1990, Vol. 85 Issue 12, p1651 

    Comments on a study which focused on the ability of propranolol to prevent the recurrence of esophageal varices after obliteration by endoscopic sclerotherapy. Opinion on the theory on the effects of reduction in variceal blood flow and intraluminal pressure caused by propranolol; Effect of the...

  • PREVENTION OF VARICEAL REBLEEDING. Stevermer, James J.; Chambliss, M. Lee // Journal of Family Practice;Sep1996, Vol. 43 Issue 3, p240 

    The article discusses nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rebleeding. It references a study by C. Villanueva et al published in the 1996 issue of the "New England Journal of Medicine." It determines whether medical therapy with...

  • Propranolol in Primary and Secondary Prophylaxis of Variceal Bleeding Among Cirrhotics in India: A Hemodynamic Evaluation. De, Binay K.; Sen, Sambit; Biswas, Pranab K.; Sengupta, Debapriya; Biswas, Jayanta; Santra, Amal; Hazra, Baburam; Maity, Ajit K. // American Journal of Gastroenterology;Aug2000, Vol. 95 Issue 8, p2023 

    OBJECTIVE: In the present study, we attempted to complete the hemodynamic assessment of propranolol response in cirrhotics with esophageal varices at high risk of bleeding, in one sitting, so as to identify nonresponders at the earliest. Some noninvasive indicators of this response were also...

  • PREDICTORS OF VARICEAL BLEEDING: SOLVING THE PUZZLE. Carey, William D.; Johnson, David A.; Cattau, Edward L. // American Journal of Gastroenterology;Oct1990, Vol. 85 Issue 10, p1426 

    Comments on a medical research which analyzed the predictors of variceal bleeding. Risk associated with esophageal varices hemorrhage; Contribution of ascites to the development of variceal bleeding; Inefficiency of endoscopy in detecting intravariceal pressure measurement.

  • VARICEAL HEAVYWEIGHTS: THE RING VERSUS THE NEEDLE. Faris, Frank; Sampliner, Richard E.; Johnson, David A.; Cattau Jr., Edward L. // American Journal of Gastroenterology;Apr1993, Vol. 88 Issue 4, p610 

    Focuses on a study which compared endoscopic ligation, new form of endoscopic treatment for esophageal varices, with endoscopic sclerotherapy, an established treatment, in a randomized perspective trial. Goal of the research; Methodology used in the study; Examples of issues of esophageal...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics