Pharmacotherapy plus endoscopic intervention is more effective than pharmacotherapy or endoscopy alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized, controlled trials - 23/08/11
Reprint requests: Mamata Ravipati, MD, VA Medical Center, 3001 Green Bay Road, North Chicago, IL 60064.Chicago, Illinois, Toledo, Ohio, USA
Abstract |
Background |
Previous clinical trials on the treatment of esophageal variceal bleeding yielded mixed results regarding the efficacy of endoscopic procedures compared with pharmacotherapy only.
Objective |
To compare the efficacy of endoscopic procedures with that of pharmacotherapy in the prevention of mortality and rebleeding.
Design and Setting |
A systematic literature review was performed to identify randomized, controlled trials of the efficacy of pharmacotherapy and endoscopic therapy. A meta-analysis was performed by using the Comprehensive MetaAnalysis software package. A 2-sided ⍺ error <.05 was considered statistically significant (P < .05).
Patients |
Twenty-five clinical trials with a total of 2159 patients were eligible for meta-analysis.
Outcome Measurements |
Relative risk (RR) with 95% confidence interval (CI) was computed for all-cause mortality, mortality from rebleeding, all-cause rebleeding, and rebleeding caused by varices.
Results |
Pharmacotherapy was as effective as endoscopic procedures in preventing rebleeding (RR 1.067; 95% CI, 0.865-1.316; P = .546), variceal rebleeding (RR 1.143; 95% CI, 0.791-1.651; P = .476), all-cause mortality (RR 0.997; 95% CI, 0.827-1.202, P = .978), and mortality from rebleeding (RR 1.171; 95% CI, 0.816-1.679; P = .39). Pharmacotherapy combined with endoscopic procedures did not reduce all-cause mortality (RR 0.787; 95% CI, 0.587-1.054; P = .108) or mortality caused by rebleeding (RR 0.786; 95% CI, 0.445-1.387; P = .405) compared with endoscopic procedures. However, combination therapy (endoscopic procedure plus pharmacotherapy) significantly reduced the incidence of all rebleeding (RR 0.623; 95% CI, 0.523-0.741; P < .001) and variceal rebleeding (RR 0.601; 95% CI, 0.440-0.820; P < .001).
Limitations |
Heterogeneity of patient population and different treatment protocols may have affected our meta-analysis.
Conclusion |
Pharmacotherapy may be as effective as endoscopic therapy in reducing rebleeding rates and all-cause mortality. Pharmacotherapy plus endoscopic intervention is more effective than endoscopic intervention alone.
Le texte complet de cet article est disponible en PDF.Abbreviation : RR
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 748. |
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| If you would like to chat with an author of this article, you may contact him at [email protected]. |
Vol 70 - N° 4
P. 658 - octobre 2009 Retour au numéro
Article précédent
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- Combination of pharmacologic and endoscopic therapy for the secondary prevention of esophageal variceal bleeding
- Walid S. Ayoub, Mindie H. Nguyen
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