A team from Indianapolis, Indiana, USA, investigated the use of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding.
The researchers performed a meta-analysis of the trials that used this procedure, as identified by electronic database searching and cross-referencing.
|Variceal bleeding was half as likely after ligation, compared with beta-blocker therapy.
Two 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 risk of first variceal bleed was 0.36 and the NNT was 4.1.
The relative risks of bleed-related mortality and all-cause mortality were 0.20 and 0.55, with respective NNTs of 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, with NNT of 13. However, there was no effect on either bleed-related mortality (relative risk [RR], 0.61) or all-cause mortality (RR, 0.95).
Thomas F. Imperiale, of the Indiana University School of Medicine and the Regenstrief Institute for Health Care, said, "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," he concluded.