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Evidence summaries

Combination Endoscopic Band Ligation and Sclerotherapy Vs Band Ligation Alone for the Secondary Prophylaxis of Esophageal Variceal Hemorrhage

Endoscopic band ligation (EBL) plus sclerotherapy is probably not more effective than EBL alone in the secondary prevention of oesophageal variceal hemorrhage. Level of evidence: "C"

A systematic review 1 including 8 studies with a total of 520 subjects was abstracted in DARE. There was no difference in oesophageal re-bleeding (5 trials, RR 1.05, 95% CI 0.67 to 1.64) or mortality (7 studies, RR 0.99, 95% CI 0.68 to 1.44). The analysis of adverse events found no significant differences in perforation, infection, posthemostasis ulcer bleeding, or cardiopulmonary arrest, but the incidence of oesophageal stricture formation was found to be higher with combination therapy (8.9) than with EBL alone (0.38%), and this difference was statistically significant.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality.

    References

    • Karsan HA, Morton SC, Shekelle PG, Spiegel BM, Suttorp MJ, Edelstein MA, Gralnek IM. Combination endoscopic band ligation and sclerotherapy compared with endoscopic band ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage: a meta-analysis. Dig Dis Sci 2005 Feb;50(2):399-406. [PubMed][DARE]

Primary/Secondary Keywords