Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding：a Meta analysis

doi:10.3969/j.issn.1006-7795.2013.05.008

Abstract

Abstract:

Objective To evaluate the efficacy of endoscopic variceal ligation (EVL) and sclerotherapy (EVS) for obliteration of esophageal varices among patients who survived an episode of first variceal hemorrhage. Methods The related literature was identified from Pubmed, Medline, Embase, CNKI, the library of Cochrane, and Wanfang database. RevMan 5.1 Software provided by the Library of Cochrane was used for Meta-analysis. Results A total of 7 randomized controlled trials were included. It was shown that the rehemorrhage rate of EVL was significantly lower than that of EVS (OR=0.54,95% CI:0.38－0.76,Z = 3.56,P = 0.000 4); Meanwhile, there was no significant difference in mortality between EVL and EVS (OR=0.79,95% CI:0.55－1.14,Z =1.27,P = 0.21). Compared with EVS, EVL could significantly reduce the complications of treatment (OR=0.22,95% CI:0.13－0.38,Z = 5.51,P=0.000 01); there was no significant difference in obliteration of varices between EVL and EVS (OR=1.46,95% CI:0.98－2.18,Z =1.88, P =0.06). Little publication bias was found with funnel plot analysis. Conclusion EVL is better than EVS in the prevention of rehemorrhagia of esophageal varices and it is the first choice for secondary prophylaxis.

Key words: esophageal varices bleeding, secondary prophylaxis, sclerotherapy, ligation, Meta analysis

CLC Number:

R571.3

CHEN Mingkai, HE Qianyu, DING Baijing, LIU Yunyan. Comparison of endoscopic ligation with sclerotherapy for preventing cirrhosis esophageal varices bleeding：a Meta analysis[J]. Journal of Capital Medical University, 2013, 34(5): 673-678.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2013.05.008

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2013/V34/I5/673

References

[1] Garcia-Pagan J C, De Gottardi A, Bosch J. Review article: the modern management of portal hypertension-primary and secondary prophylaxis of variceal bleeding in cirrhotic patients[J]. Aliment Pharmacol Ther,2008, 28(2):178-186.
[2] Garcya-Pagan J C, Villanueva C, Albillos A, et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: A multicentre randomised controlled trial[J]. Gut,2009,58(8):1144-1450.
[3] Villanueva C, Minana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding[J]. N Engl J Med,2001,345(9):647-655.
[4] Ferrari A P, de Paulo G A,de Macedo C M,et al.Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices[J].Arq Gastroenterol,2005,42(2):72-76.
[5] Masci E, Stigliano R, Mariani A,et al. Prospective multicenter randomized trial comparing banding ligation with sclerotherapy of esophageal varices[J]. Hepatogastroenterology, 1999, 46(27):1769-1773.
[6] Baroncini D,Milandri G L,Borioni D,et al.A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal Varices[J].Endoscopy,1997,29(4):235-240.
[7] Liu D L,Huo J R,Wu X P,et al. Comparative clinical study of ligation versus sclerothetapy in the treatment of bleeding esophageal varices[J]. Hunan Medical,1999,16(2): 90-91.
[8] De la Pena J,Rivero M,Sanchez E,et al.Variceal ligation compared with Endoscopic sclerotherapy for variceal hemorrhage: prospective randomized Trial[J]. Gastrointest Endosc,1999,49(4):417-423.
[9] Hou M C, Lin H C, Kuo B I,et al. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial[J]. Hepatology,1995,21(6):1517-1522.
[10] Lo G H, Lai K H, Cheng J S, et al.A prospective,randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices[J]. Hepatology,1995,22(2):466-471.
[11] Committee of esophageal varicosity,Society of digestive Endoscopy of Chinese Medical Association. Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract(2009)[J]. Chin J Gig Endosc, 2010, 27(1): 1-4.
[12] Baron T H, Wong Kee, Song L M. Endoscopic variceal band ligation[J]. Am J Gastroenterol,2009,104(5):1083-1085.
[13] Garcia-Tsao G, SanyalA J, G race N D, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage incirrhosis[J]. Hepatology, 2007,46:(3)922-938.
[14] 潘黎明,毛晓燕,曹唯.无痛内镜下治疗食管静脉曲张的护理[J].临床误诊误治,2010,23(10):44-45.
[15] 陈强,刘迎娣.内镜下组织黏合剂联合硬化剂注射治疗食管胃底静脉曲张的疗效观察[J].中国煤炭工业医学杂志,2012,15(2):214-215.