Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis  

作　　者：Natalie Funakoshi Frédérique Ségalas-Largey Yohan Duny Frédéric Oberti Jean-Christophe Valats Michael Bismuth Jean-Pierre Daurès Pierre Blanc 

机构地区：[1]Department of Hepato-gastroenterology B, Saint Eloi Hospital, University Hospital of Montpellier [2]Department of Statistics, University Hospital of Nimes [3]Department of Hepato-gastroenterology, University Hospital of Angers

出　　处：《World Journal of Gastroenterology》2010年第47期5982-5992,共11页世界胃肠病学杂志（英文版）

摘　　要：AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, P<0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was signif icantly lower for the combined treatment group (OR: 1.83, 95% CI:1.16-2.90, P= 0.009), as well as overall mortality (OR: 1.43, 95% CI:1.03-1.98, P= 0.03). CONCLUSION: Combination therapy should thus be recommended as the fi rst line treatment for secondary prophylaxis of oesophageal variceal bleeding.AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, P<0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was signif icantly lower for the combined treatment group (OR: 1.83, 95% CI:1.16-2.90, P= 0.009), as well as overall mortality (OR: 1.43, 95% CI:1.03-1.98, P= 0.03). CONCLUSION: Combination therapy should thus be recommended as the fi rst line treatment for secondary prophylaxis of oesophageal variceal bleeding.

关 键 词：Oesophageal varices Portal hypertension CIRRHOSIS Secondary prevention Β-BLOCKERS Banding ligation 

分 类 号：R571[医药卫生—消化系统]