Copyright
©The Author(s) 2018.
World J Gastroenterol. Jul 14, 2018; 24(26): 2902-2914
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2902
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2902
Table 1 Results from meta-analyses comparing band ligation with other interventions in terms of all-cause related rebleeding, variceal rebleeding, all-cause related mortality, bleeding related mortality and complication rates
Study (reference) | Publication year | Country | Method | Number of studies | Number of patients | All-cause related rebleeding RR or OR/CI/I2 | Variceal rebleedingRR or OR/CI /I2 | All-cause related mortalityRR or OR/CI /I2 | Bleeding related mortalityRR or OR/CI/I2 | ComplicationsRR or OR/CI/I2 |
Singh et al[16] | 2002 | United States | EBL vs EST + EBL | 7 | 453 | NR | 1.12/ 0.69-1.81/ NR | NR | 1.1/ 0.70-1.74/ NR | 0.37/ 0.21-0.62/ NR |
Karsan et al[22] | 2005 | United States | EBL vs EST + EBL | 8 | 520 | NR | 1.05/ 0.67-1.64/ NS | 0.99/ 0.68-1.44/ NS | NR | NR |
1Gonzalez et al[15] | 2008 | Spain | 2Combination therapy vs EBL | 4 | 404 | 0.62/ 0.44-0.87/ 40% | NR | 0.79/ 0.44-1.43/ 54% | NR | NR |
Cheung et al[17] | 2009 | Canada | EBL vs PT | 6 | 698 | 0.96/ 0.73-1.30/ 62% | NR/ NR/ 79% | 1.20/ 0.92-1.57/ 0 | NR | 0.90/ 0.70-1.15/ 0 |
EBL+PT vs EBL | 4 | 404 | 0.57/ 0.31-1.08/ 60% | 0.38/ 0.19-0.76/ 0 | 0.90/ 0.41-1.98/ 45% | 3.4/ 1.4-8.2/ 74% | ||||
EBL+PT vs PT | 2 | 279 | 0.76/ 0.56-1.03/ 0 | 0.58/ 0.40-0.85/ 0 | 0.94/ 0.54-1.63/ 31% | NR | ||||
Ding et al[13] | 2009 | China | β-blockers + ISMN vs EBL | 4 | 476 | 0.94/ 0.64-1.38 71.50% | NR | 0.81/ 0.61-1.08/ 0 | 0.76/ 0.31-1.42/ 38.90% | 1.26/ 0.93-1.70/ 42.70% |
1Funakoshi et al[14] | 2010 | France | EBL vs EBL + β-blockers | 3 | 252 | 3.16/ 1.76-5.34/ 0 | NR | 1.78/ 0.92-3.43/ 0 | NR | NR |
Li et al[18] | 2011 | China | EBL vs β-blockers + ISMN | 6 | 687 | 0.95/ 0.65-1.40/ NR | 0.89/ 0.53-1.49/ NR | 1.25/ 1.01-1.55/ NR | 1.16/ 0.68-1.97/ NR | NR |
Thiele et al[19] | 2012 | Denmark | 3EBL+PT vs monotherapy | 9 | 955 | 0.68/ 0.54-0.85/ 1% | 0.67/ 0.54-0.84/0 | 0.89/ 0.65-1.21/ 0 | 0.52/ 0.27-0.99/ NR | 1.42/ 0.94-2.13/ 69% |
Ko et al[21] | 2012 | South Korea | EBL + β-blockers vs β-blockers | 4 | 409 | 0.78/ 0.58-1.04/ NR | 0.60/ 0.41-0.88/ NR | 1.21/ 0.88-1.65/ NR | ||
Dai et al[20] | 2015 | China | EBL vs EST | 14 | 1236 | 0.68/ 0.57-0.81/ 9.00% | NR | 0.95/ 0.77-1.17/ 32.80% | NR | 0.28/ 0.13-0.58/ 86.50% |
Albillos et al[23] | 2017 | Spain | EBL + β-blockers vs EBL | 4 | 416 | 0.36/ 0.21-0.59/ NR | 0.52/ 0.25-1.11/ NR | 0.50/ 0.28-0.89/ NR | NR | NR |
EBL + β-blockers vs β-blockers | 3 | 389 | 1.0/ 0.68-1.47/ NR | 0.81/ 0.53-1.23/ NR | 1.19/ 0.76-1.87/ NR |
Table 2 Characteristics of the included randomized trials
Study (reference) | Publication year | Country | Number of subjects |
Monici et al[35] | 2010 | Brazil | 70 |
Luz et al[26] | 2011 | Brazil | 83 |
Santos et al[34] | 2011 | Brazil | 38 |
Lo et al[31] | 2013 | Taiwan | 118 |
Stanley et al[30] | 2014 | United Kingdom | 64 |
Chen et al[28] | 2016 | China | 96 |
Holster et al[32] | 2016 | Netherlands | 72 |
Mansour et al[27] | 2017 | Egypt | 120 |
Lv et al[33] | 2017 | China | 49 |
Hanif et al[29] | 2017 | Pakistan | 60 |
Table 3 Baseline characteristics of the patients included in the review
Study (reference) | Patients | Gender (M/F) | Age (range or ± SD) | CP class (A/B/C) | Cirrhosis etiology (agent %) |
Monici et al[35] | EBL + EST: 36 | 25/11 | 47.8 (30-68) | 28/8/0 | Alcohol/virus/alcohol+virus/cryptogenic/autoimmune/PSC/PBC 12/13/3/5/2/1 |
EBL + MC: 34 | 26/8 | 48.5 (22-71) | 29/5/0 | Alcohol/virus/alcohol+ virus/cryptogenic/autoimmune/PSC/PBC 8/11/3/9/1/2 | |
Luz et al[26] | EBL: 44 | NR | NR | 2/22/20 | Alcohol/virus/secondary biliary cirrhosis/cryptogenic/PBC 43.2/43.2/9.1/2.3/2.3 |
EST: 39 | NR | NR | 3/21/15 | Alcohol/virus/secondary biliary cirrhosis/cryptogenic/PBC 43.6/38.5/7.7/5.1/5.1 | |
Santos et al[34] | EBL: 20 | 13/7 | 52 ± 12.6 | 0/4/16 | Alcohol/HCV/alcohol+HCV/other 30/30/15/25 |
CI: 18 | 14/4 | 51 ± 8.2 | 0/3/15 | Alcohol/HCV/alcohol+HCV/other 39/33/6/22 | |
Lo et al[31] | EBL+ vasoconstrictors: 60 | 49/11 | 52.5 ± 14.4 | 18/32/10 | Alcohol/HBV/HCV/HBV+HCV/cryptogenic 40/22/30/3/5 |
EBL+PPIs: 58 | 49/9 | 54.2 ± 9.7 | 15/24/19 | Alcohol/HBV/HCV/HBV+HCV/cryptogenic 38/29/26/3/2/2 | |
Stanley et al[30] | EBL: 31 | 21/10 | 49.6 ± 12.87 | 11/28/25 | Alcohol/NAFLD/PBC/DICLD 91/5/3/2 |
Carvedilol: 33 | 22/11 | 51.4 ± 10.8 | |||
Chen et al[28] | EBL: 48 | 32/16 | 56 ± 10 | 19/29/0 | HBV/HCV/Alcohol/autoimmune/other 59/4/6/8/23 |
EST: 48 | 31/17 | 54 ± 11 | 20/28/0 | HBV/HCV/alcohol/autoimmune/other 75/0/2/10/13 | |
Holster et al[32] | EBL+β-blockers: 35 | 23/12 | 54 (30-71) | 13/18/4 | Alcohol/HBV+HCV/alcohol + HBV+HCV/autoimmune liver+biliary disease/other 51/3/8/26/11 |
TIPS: 37 | 18/19 | 56 (37-75) | 13/19/5 | Alcohol/HBV+HCV/alcohol + HBV+HCV/autoimmune liver+biliary disease/other 35/19/8/24/14 | |
Mansour et al[27] | EBL: 60 | 34/26 | NR | 8/20/32 | HCV/HBV/HCV+HBV 86.67/6.66/6.66 |
EBL + EST: 60 | 44/16 | NR | 14/22/24 | HCV/HBV/HCV+HBV 86.67/6.66/6.66 | |
Lv et al[33] | EBL+propranolol: 25 | 16/8 | 46 (38-56) | 10/14/1 | HBV/HCV/alcohol/AH/HBV+AH/cryptogenic 86.67/13.3/0 |
TIPS: 24 | 13/12 | 49 (46-62) | 9/13/2 | HBV/HCV/alcohol/AH/HBV+AH/cryptogenic 83/4/4/4/0/4 | |
Hanif et al[29] | EBL+ propranolol: 30 | 25/5 | 56.30 ± 5.80 | NR | NR |
Propranolol: 30 | 13/17 | 57.63 ± 5.98 | NR | NR |
Table 4 Results of individual trials comparing band ligation with other interventions in terms of variceal obliteration, rebleeding and variceal recurrence
Study (reference) | Treatment | Mean sessions to obliterate | Rate of obliteration /time to obliterate (%) | Rebleeding rate(%) | Variceal recurrence rate |
Endoscopic band ligation vs endoscopic sclerotherapy | |||||
Luz et al[26] | EBL | NR | 75 at 5 d | 25 at 5 d | NR |
EST | 84.6 at 5 d | 15.4 at 5 d | |||
Mansour et al[27] | EBL | 3.43 ± 0.67 | 100 at 15.6 wk | 16.70 | 26.7 at 3 mo 10 at 6 mo |
EBL + EST | 2.22 ± 0.92 | 100 at 8.64 wk | 13.30 | 20 at 3 mo 10 at 6 mo | |
Chen et al[28] | EBL | 3 ± 0.5 | 25 | 14.60 | NR |
EBL + EST | 3 ± 0.6 | 16.30 | 35.40 | ||
Endoscopic band ligation vs β-blockers | |||||
Stanley et al[30] | EBL | NR | 65 | 35.50 | NR |
Carvedilol | 68 | 36.40 | |||
Endoscopic band ligation + β-blockers vs β-blockers | |||||
Hanif et al[29] | EBL + propranolol | NR | NR | 10 | NR |
Propranolol | 40 | ||||
Endoscopic band ligation + PPIs vs endoscopic band ligation + vasoconstrictors | |||||
Lo et al[31] | EBL + vasoconstrictors | NR | NR | 1.7 at 6 d 8.3 at 6-42 d | NR |
EBL + PPIs | 1.7 at 6 d 8.6 at 6-42 d | ||||
Endoscopic band ligation + β-blockers vs TIPS | |||||
Holster et al[32] | EBL + β-blockers | NR | 71 at 2 yr | 26 at 2 yr | NR |
TIPS | 73 at 2 yr | 0 at 2 yr | |||
Lv et al[33] | EBL + propranolol | NR | NR | 37 at 6 mo 45 at 12 mo 45 at 24 mo 52 at 30.4 mo | NR |
TIPS | 5 at 6 mo 15 at 12 mo 20 at 24 mo 17 at 30.9 mo | ||||
Santos et al[34] | EBL | 3.17 ± 1.15 | 90 at 75.4 d | 0 | 33 at 14.6 mo |
CI | 3 ± 1.36 | 78 at 55.4 d | 10 | 57 at 7.9 mo | |
Endoscopic band ligation + endoscopic sclerotherapy vs endoscopic band ligation + microwave coagulation | |||||
Monici et al[35] | EBL + EST | 2.75 ± 1.92 | 97.30 | 8.30 | 27.7 at 9.5 mo 19.5 at 12 mo |
EBL + MC | 2.38 ± 1.63 | 97.10 | 0 | 17.6 at 9.16 mo 17.5 at 12 mo |
Table 5 Results of individual trials comparing band ligation with other interventions in terms of mortality
Study (reference) | Treatment | Mean hospitalization days(range or ± SD) | Mortality rate(%) | Follow up (range or ± SD) |
Endoscopic band ligation vs endoscopic sclerotherapy | ||||
Luz et al[26] | EBL | NR | 13.60 | 5 d |
EST | 7.70 | 5 d | ||
Mansour et al[27] | EBL | NR | No difference | 6 mo |
EBL + EST | ||||
Endoscopic band ligation vs endoscopic band ligation + endoscopic sclerotherapy | ||||
Chen et al[28] | EBL | NR | 2.10 | 6 mo |
EBL + EST | 6.30 | |||
Endoscopic band ligation vs β-blockers | ||||
Stanley et al[30] | EBL | NR | 51.60 | 26.3 mo |
Carvedilol | 27.30 | |||
Endoscopic band ligation + β-blockers vs β-blockers | ||||
Hanif et al[29] | EBL + propranolol | NR | NR | 6 mo |
Propranolol | ||||
Endoscopic band ligation + PPIs vs endoscopic band ligation + vasoconstrictors | ||||
Lo et al[31] | EBL + vasoconstrictors | 9.4 ± 2.3 | 6.7 at 42 d | 42 d |
EBL + PPIs | 8.8 ± 3.8 | 5.2 at 42 d | ||
Endoscopic band ligation + β-blockers vs TIPS | ||||
Holster et al[32] | EBL + β-blockers | 8.8 ± 5.4 | 20 at 2 yr | 23.4 mo |
TIPS | 12.4 ± 11.2 | 22 at 2 yr | ||
Lv et al[33] | EBL + propranolol | NR | 12 at 6 mo 12 at 12 mo 16 at 24 mo 33 at 30.4 mo | 30.4 mo |
TIPS | 16 at 6 mo 17 at 12 mo 27 at 24 mo 33 at 30.9 mo | 30.9 mo | ||
Endoscopic band ligation vs cyanoacrylate injection | ||||
Santos et al[34] | EBL | NR | 55 | 338 ± 189 d |
CI | 56 | |||
Endoscopic band ligation + endoscopic sclerotherapy vs endoscopic band ligation + microwave coagulation | ||||
Monici et al[35] | EBL + EST | NR | 5.50 | 36.1 (15-53) mo |
EBL + MC | 5.88 | 33.6 (14-54) mo |
- Citation: Aggeletopoulou I, Konstantakis C, Manolakopoulos S, Triantos C. Role of band ligation for secondary prophylaxis of variceal bleeding. World J Gastroenterol 2018; 24(26): 2902-2914
- URL: https://www.wjgnet.com/1007-9327/full/v24/i26/2902.htm
- DOI: https://dx.doi.org/10.3748/wjg.v24.i26.2902