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

Table 1 Study characteristics

Author	Country	Publication type	n	Length of follow-up (mo)
Combination therapy vs sclerotherapy
Westaby et al[36]	United Kingdom	Article	53	6
Jensen et al[37]	Denmark	Article	31	12
Bertoni et al[38]	Italy	Letter	28	2
Gerunda et al[39]	Italy	Abstract	60	6
Lundell et al[40]	Sweden	Article	41	8
Kanazawa et al[32]	Japan	Abstract	43	27
Vinel et al[41]	France	Article	74	3
Acharya et al[42]	India	Article	114	24
Avgerinos et al[43]	Greece	Article	85	23.9
Villanueva et al[33]	Spain	Article	40	26
Vickers et al[44]	United Kingdom	Article	73	24
Elsayed et al[34]	Egypt	Article	178	21
Benedeto-Stojanov et al[45]	Yugoslavia	Abstract	65	39
Dowidar et al[35]	Egypt	Article	40	16.2
Combination therapy vs banding ligation
Abdel-Rahim et al[46]	Egypt	Abstract	50	< 3
Lo et al[12]	China	Article	122	12
de la Peña et al[13]	Spain	Article	84	16

Table 2 Combination therapy vs banding ligation

Author	Mean age (yr)	Men (%)	Non cirrhotic portal hypertension (%)	Alcoholic liver disease (%)	Child class A-B-C (%)	Size of varices small-medium-large (%)
Combination therapy vs sclerotherapy
Westaby et al[36]	48.6	62	17	43	16-43-41	0-34-66
Jensen et al[37]	46.5	87	0	84	26-45-29	3-32-65
Bertoni et al[38]	59.1	64	0	57	32-32-36	7-46.5-46.5
Gerunda et al[39]	NA	NA	0	50	NA	NA
Lundell et al[40]	56.4	54	0	63	22-27-51	NA
Kanazawa et al[32]	NA	NA	0	NA	NA	NA
Vinel et al[41]	55.7	78	0	89	NA	0-32-68
Acharya et al[42]	34.7	85	11	7	60-40-0	0-0-100
Avgerinos et al[43]	58.2	72	0	26	74-19-7	8-45-47
Villanueva et al[33]	56.8	57.5	0	50	30-70-0	7.5-62.5-30
Vickers et al[44]	55.1	59	15	40	26-51-23	7-26-64
Elsayed et al[34]	43.0	84	0	NA	55-29-16	NA
Benedeto-Stojanov et al[45]	NA	NA	0	NA	NA	NA
Dowidar et al[35]	46.0	90	0	0	45-50-5	20-72.5-7.5
Combination therapy vs banding ligation
Abdel-Rahim et al[46]	NA	NA	NA	NA	NA	NA
Lo et al[12]	52.0	77	0	30	19-47-34	0-42-58
de la Peña et al[13]	60.0	75	0	66	15-56-29	21-54-25

NA: Not available.

Table 3 Combination therapy vs sclerotherapy

Study	Random- isation	Investigator blinding	Estimate of sample size	Intention to treat analysis	Poynard’s quality score (%)	Pagliaro’s quality score (%)
Combination therapy vs sclerotherapy
Westaby et al[36]	Yes	No	No	No	31	35
Jensen et al[37]	Yes	Double blinded	No	No	65	67
Bertoni et al[38]	Yes	Single blinded	No	No	54	44
Gerunda et al[39]	Yes	No	No	No	19	12
Lundell et al[40]	Yes	Single blinded	No	Yes	50	61
Kanazawa et al[32]	Yes	No	No	No	19	18
Vinel et al[41]	Yes	No	Yes	Yes	73	43
Acharya et al[42]	Yes	Double blinded	Yes	Yes	92	96
Avgerinos et al[43]	Yes	Single blinded	Yes	Yes	77	83
Villanueva et al[33]	Yes	No	No	No	55	67
Vickers et al[44]	Yes	Single blinded	Yes	Yes	83	74
Elsayed et al[34]	Yes	No	No	No	50	31
Benedeto-Stojanov et al[45]	Yes	NA	NA	NA	29	8
Dowidar et al[35]	Yes	Single blinded	No	No	54	50
Combination therapy vs banding ligation
Abdel-Rahim et al[46]	Yes	NA	NA	NA	8	17
Lo et al[12]	Yes	Single blinded	Yes	Yes	81	85
de la Peña et al[13]	Yes	No	Yes	No	69	82

NA: Not available.

Table 4 Meta-analysis comparing endoscopic therapy (sclerotherapy or banding ligation) with combined endoscopic and β-blocker therapy

	SCL/BL, n/N (%)	SCL/BL + BB, n/N (%)	No. of trials analysed	I2	OR (95% CI)	P for heterogeneity	P-value
All-cause rebleeding
6 mo	121/410 (29.5)	83/428 (19.4)	11	36	1.70 (1.24-2.34)1	0.11	0.01
12 mo	142/376 (37.8)	85/392 (21.7)	10	62.3	2.22 (1.25-3.99)2	0.004	0.007
24 mo	106/272 (40.0)	80/285 (28.1)	7	50	1.67 (0.99-2.81)2	0.08	0.05
Overall	211/537 (39.3)	132/561 (23.5)	16	12.8	2.20 (1.69-2.85)1	0.31	< 0.0001
Mortality
6 mo	39/309 (12.6)	33/319 (10.3)	9	0	1.23 (0.75-2.04)1	0.53	0.41
12 mo	33/246 (13.4)	30/259 (11.6)	7	0	1.18 (0.69-1.99)1	0.79	0.55
24 mo	58/230 (25.2)	37/244 (15.2)	6	0	1.83 (1.16-2.90)1	0.92	0.009
Overall	98/536 (18.3)	76/560 (13.6)	16	0	1.43 (1.03-1.98)1	0.97	0.03

¹Fixed effect model;

²Random effect model. SCL: Sclerotherapy; BL: Banding ligation; BB: β-blockers; OR: Odds ratio; CI: Confidence interval.

Table 5 Subgroup meta-analysis including trials comparing sclerotherapy with sclerotherapy and β-blockers

	SCL, n/N (%)	SCL + BB, n/N (%)	No. of trials analysed	I2	OR (95% CI)	P for heterogeneity	P-value
All-cause rebleeding
6 mo	91/311 (29.2)	74/325 (22.8)	9	5.8	1.36 (0.95-1.95)1	0.39	0.09
12 mo	105/277 (38.0)	69/289 (23.9)	8	69.0	2.03 (0.97-4.25)2	0.002	0.06
24 mo	61/173 (35.3)	56/182 (30.8)	5	45.7	1.26 (0.80-2.00)1	0.12	0.33
Overall	162/413 (39.2)	110/433 (25.4)	13	20.7	2.00 (1.49-2.69)1	0.23	< 0.0001
Mortality
6 mo	30/247 (12.1)	29/259 (11.2)	8	0	1.07 (0.61-1.87)1	0.57	0.82
12 mo	21/184 (11.4)	23/199 (11.6)	6	0	0.98 (0.52-1.85)1	0.83	0.96
24 mo	34/168 (20.2)	26/184 (14.1)	5	0	1.56 (0.89-2.73)1	0.97	0.12
Overall	71/412 (17.2)	59/432 (13.7)	13	0	1.33 (0.91-1.94)1	0.97	0.14

¹Fixed effect model;

²Random effect model. SCL: Sclerotherapy; BL: Banding ligation; BB: β-blockers; OR: Odds ratio; CI: Confidence interval.

Table 6 Subgroup meta-analysis including trials comparing banding ligation with banding ligation and β-blockers

	BL, n/N (%)	BL + BB, n/N (%)	No. of trials analysed	I2	OR (95% CI)	P for heterogeneity	P-value
Overall all-cause rebleeding	49/124 (39.5)	22/128 (17.2)	3	0	3.16 (1.76-5.34)1	0.85	< 0.0001
Mortality	27/124 (21.8)	17/128 (13.3)	3	0	1.78 (0.92-3.43)1	0.53	0.09

¹Fixed effect model. SCL: Sclerotherapy; BL: Banding ligation; BB: β-blockers; OR: Odds ratio; CI: Confidence interval.