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Combination Endoscopic Band Ligation and Sclerotherapy Compared with Endoscopic Band Ligation Alone for the Secondary Prophylaxis of Esophageal Variceal Hemorrhage: A Meta-Analysis

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Endoscopic band ligation (EBL) is the community-accepted standard therapy for the secondary prophylaxis of esophageal variceal hemorrhage. Recent data indicate that combination EBL and sclerotherapy may be a more effective therapy than EBL alone. Yet existing data are conflicting. We therefore performed a meta-analysis to compare the efficacy and safety of EBL and sclerotherapy versus EBL alone for the secondary prophylaxis of esophageal variceal hemorrhage. We performed a systematic review of two computerized databases (MEDLINE and EMBASE) along with manual-searching of published abstracts to identify relevant citations without language restrictions from 1990 to 2002. Eight studies met explicit inclusion criteria. We performed meta-analysis of these studies to pool the relative risk for the following outcomes: esophageal variceal rebleeding, death, number of endoscopic sessions to achieve variceal obliteration, and therapeutic complications. There were no significant differences between EBL and sclerotherapy versus EBL alone in the risk of esophageal variceal rebleeding (RR = 1.05; 95% CI = 0.67–1.64; P = 0.83), death (RR = 0.99; 95% CI = 0.68–1.44; P = 0.96), or number of endoscopic sessions to variceal obliteration (RR = 0.23; 95% CI = 0.055–0.51; P = 0.11). However, the incidence of esophageal stricture formation was significantly higher in the EBL group than in the sclerotherapy group. There is no evidence that the addition of sclerotherapy to endoscopic band ligation changes clinically relevant outcomes (variceal rebleeding, death, time to variceal obliteration) in the secondary prophylaxis of esophageal variceal hemorrhage. Moreover, combination EBL and sclerotherapy had more esophageal stricture formation than EBL alone.

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Authors and Affiliations

  1. Divisions of Gastroenterology and Hepatology, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Brennan M. R. Spiegel MD & Ian M. Gralnek MD, MSHS

  2. General Internal Medicine/Health Services Research, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Paul G. Shekelle MD, PhD

  3. Center for the Health Sciences, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California

    Hetal A. Karsan MD, Brennan M. R. Spiegel MD, Marc A. Edelstein MD & Ian M. Gralnek MD, MSHS

  4. RAND Health, Los Angeles, California, USA

    Sally C. Morton PhD, Paul G. Shekelle MD, PhD & Marika J. Suttorp MS

  5. CURE Digestive Diseases Research Center, Los Angeles, California, USA

    Brennan M. R. Spiegel MD & Ian M. Gralnek MD, MSHS

  6. Center for the Study of Digestive Healthcare Quality and Outcomes, Los Angeles, California, USA

    Hetal A. Karsan MD, Brennan M. R. Spiegel MD, Marc A. Edelstein MD & Ian M. Gralnek MD, MSHS

  7. Southern California Evidence-Based Practice Center, Los Angeles, California, USA

    Sally C. Morton PhD, Paul G. Shekelle MD, PhD & Marika J. Suttorp MS

Authors
  1. Hetal A. Karsan MD
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  2. Sally C. Morton PhD
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  3. Paul G. Shekelle MD, PhD
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  4. Brennan M. R. Spiegel MD
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  5. Marika J. Suttorp MS
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  6. Marc A. Edelstein MD
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  7. Ian M. Gralnek MD, MSHS
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Correspondence to Ian M. Gralnek MD, MSHS.

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Karsan, H.A., Morton, S.C., Shekelle, P.G. et al. Combination Endoscopic Band Ligation and Sclerotherapy Compared with Endoscopic Band Ligation Alone for the Secondary Prophylaxis of Esophageal Variceal Hemorrhage: A Meta-Analysis. Dig Dis Sci 50, 399–406 (2005). https://doi.org/10.1007/s10620-005-1618-9

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  • DOI: https://doi.org/10.1007/s10620-005-1618-9

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