Brief Articles
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World J Gastroenterol. May 7, 2009; 15(17): 2151-2155
Published online May 7, 2009. doi: 10.3748/wjg.15.2151
Efficacy of β-adrenergic blocker plus 5-isosorbide mononitrate and endoscopic band ligation for prophylaxis of esophageal variceal rebleeding: A meta-analysis
Shi-Hua Ding, Jun Liu, Jian-Ping Wang
Shi-Hua Ding, Jun Liu, Jian-Ping Wang, Department of Gastroenterology, The Affiliated Shenzhen Hospital, Nanfang Medical University, Shenzhen 518035, Guangdong Province, China
Author contributions: Ding SH designed the study and wrote the manuscript; Wang JP collected the data; Liu J analyzed the available data and assessed the methodological quality of each study in accordance with the criteria by Jadad.
Correspondence to: Shi-Hua Ding, Department of Gastroenterology, The Affiliated Shenzhen Hospital, Nanfang Medical University, Shenzhen 518035, Guangdong Province, China. shding123@163.com
Telephone: +86-755-83366388
Fax: +86-755-83356952
Received: September 21, 2008
Revised: December 18, 2008
Accepted: December 25, 2008
Published online: May 7, 2009
Abstract

AIM: To systematically assess the efficacy and safety of β-adrenergic blocker plus 5-isosorbide mononitrate (BB + ISMN) and endoscopic band ligation (EBL) on prophylaxis of esophageal variceal rebleeding.

METHODS: Randomized controlled trials (RCTs) comparing the efficacy and safety of BB + ISMN and EBL on prophylaxis of esophageal variceal rebleeding were gathered from Medline, Embase, Cochrane Controlled Trial Registry and China Biological Medicine database between January 1980 and August 2007. Data from five trials were extracted and pooled. The analyses of the available data using the Revman 4.2 software were based on the intention-to-treat principle.

RESULTS: Four RCTs met the inclusion criteria. In comparison with BB + ISMN with EBL in prophylaxis of esophageal variceal rebleeding, there was no significant difference in the rate of rebleeding [relative risk (RR), 0.79; 95% CI: 0.62-1.00; P = 0.05], bleeding-related mortality (RR, 0.76; 95% CI: 0.31-1.42; P = 0.40), overall mortality (RR, 0.81; 95% CI: 0.61-1.08; P = 0.15) and complications (RR, 1.26; 95% CI: 0.93-1.70; P = 0.13).

CONCLUSION: In the prevention of esophageal variceal rebleeding, BB + ISMN are as effective as EBL. There are few complications with the two treatment modalities. Both BB + ISMN and EBL would be considered as the first-line therapy in the prevention of esophageal variceal rebleeding.

Keywords: Meta-analysis; Esophageal variceal rebleeding; Endoscopic band ligation; β-adrenergic blocker; 5-isosorbide mononitrate; Prophylaxis