Comparative Study Of Medical Therapy And Endoscopic Variceal Ligation In Prevention Of Esophageal Variceal Rebleeding With Hepatic Cirrhosis: A Meta-analysis

Objectives: To compare the efficacy of medical therapy( β -blockers plus nitrates) and endoscopic variceal ligation(EVL) in preventing of variceal rebleeding and bleeding-related mobidity with cirrhosis.Materials and Methods: We searched 39 papers in electronic database from 1990 to 2003 and brought in 4 studies in which the testing were randomize-controlled design consists of 47] patients as according to our criteria. About the 4 studies two investigators had independently abstracted the testing design, clinical characteristics and the experiment results. We selected the risk difference(RD) and the number needed to treat(NNT) as our study index.Results: There was no significant difference between medical therapy and EVL in rebleeding from variceal, upper digestive tract, complications and mortality. The pooled RD and 95%CI were 0(-0.18~0.18), 0.04(-0.19~0.27), ~0.02(-0.10~0.05) and 0.06( ?0.02 ~ 0.14) respectively. However, the incidence of portal hypertensive gastropathy(PHG) is higher in EVL than in medical therapy, the pooled risk(RD) is 0.22(0.13?.30) with NNT of 5. By subgrade analysis we found that medical therapy is superior to EVL in preventing rebleeding from upper digestive tract with Child-pugh A and B(RD, 0.27; 95%C1, 0.13-0.41; NNT, 4).Conclusions: Compared with EVL, P -blockers plus nitrates reduces the risk of PHG happening but has no effection on rebleeding and mortality in hepatic cirrhosis patients who had variceal bleeding before. By subgrading analysis medical therapy could significantly reduce the risk of rebleeding from upper digestive tract for patients with Child-pugh A and B.