7 RCTs were included in a meta-analysis (n=547) 1. 5 studies included patients with active bleeding and information on hemostasis (106 patients). 5 studies provided information on mortality due to bleeding.
For patients with actively bleeding varices the hemostasis rates was similar after ligation and sclerotherapy (OR, 1.14, 95% CI, 0.44 to 2.90). Rebleeding was less common with ligation therapy compared with sclerotherapy (OR, 0.52, 95%CI, 0.37 to 0.74). The mortality rate (OR, 0.67, CI, 0.46 to 0.98), and the rate of death due to bleeding (OR, 0.49, CI, 0.24 to 0.996) were lower in patients treated with ligation.
The rate of rebleeding due to varices was lower in patients who received ligation (OR, 0.47, CI, 0.29 to 0.78), as was the rate of rebleeding due to treatment induced ulcers (OR, 0.56, CI 0.28 to
1.15; p=0.16). Death not due to bleeding was also less frequent in the ligation group (OR, 0.62, CI, 0.35 to 1.07; p=0.11).
Six of the seven studies suggested that one to three fewer endoscopic treatment sesions would be required to achieve variceal obliteration with ligation. The costs of the equipment for either
ligation or sclerotherapy are similar.
Another systematic review 2 including 10 RCTs (4 full reports, 6 abstracts) with a total of 653 subjects was abstracted in DARE. There was no significant difference in primary haemostasis in actively bleeding patients (OR 1.2, 95% CI 0.5 to 2.8) in favour of sclerotherapy. Rebleeding rate was significantly higher for sclerotherapy (OR 1.6, 95% CI 1.1 to 2.4). Early mortality was non-significantly higher for sclerotherapy (OR 1.3, 95% CI 0.8 to 1.9). Complication rates were higher after sclerotherapy (OR 2.6, 95% CI 1.8 to 3.9). Number of treatment sessions required for eradication of varices was significantly less with endoscopic banding ligation (3.8 ± 1.6 vs 5.8 ± 2.2, p<0.05).
Primary/Secondary Keywords