Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Hepatol. May 27, 2026; 18(5): 117049
Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.117049
Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.117049
Carvedilol and nonselective-beta-blockers vs endoscopic ligation for prophylaxis of esophageal variceal hemorrhage in cirrhosis: Systematic review and meta-analysis
Resha Dermawansyah Rusman, Muhammad Luthfi Parewangi, Fardah Akil, Nu'man A S Daud, Rini R Bachtiar, Susanto Hendra Kusuma, Amelia Rifai, Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Sulawesi Selatan, Indonesia
Akiko Syawalidhany Tahir, Department of Internal Medicine, Primaya Hertasning Hospital, Makassar 90221, Sulawesi Selatan, Indonesia
Author contributions: Rusman RD conceived and designed the study, developed the search strategy, collected and analyzed the data, and drafted the initial manuscript; Parewangi ML and Akil F supervised the study methodology, provided critical intellectual input, and reviewed the manuscript for important content; Daud NAS and Bachtiar RR contributed to data interpretation, literature screening, and risk of bias assessment; Kusuma SH, Rifai A, and Tahir AS assisted in manuscript editing, statistical interpretation, preparation of the final version, clinical contextualization, interpretation of findings, and critical revision of the manuscript; All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: Claude (Anthropic) was used during manuscript preparation. Grammarly was also used for grammar and spelling checks. AI assistance was limited strictly to language refinement, given that all authors are non-native English speakers. The authors take full responsibility for the integrity, originality, and accuracy of all content in this manuscript. AI tools were used solely as language and editing aids and did not contribute to the scientific substance, data, or conclusions of this work.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Resha Dermawansyah Rusman, MD, Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Jl Perintis Kemerdekaan Km 10, Makassar 90245, Sulawesi Selatan, Indonesia.
Received: December 1, 2025
Revised: January 1, 2026
Accepted: February 25, 2026
Published online: May 27, 2026
Processing time: 177 Days and 17 Hours
Revised: January 1, 2026
Accepted: February 25, 2026
Published online: May 27, 2026
Processing time: 177 Days and 17 Hours
Core Tip
Core Tip: This systematic review and meta-analysis demonstrate that carvedilol, a nonselective beta-blocker, is superior to endoscopic variceal ligation for the primary prevention of esophageal variceal bleeding in patients with cirrhosis. Carvedilol significantly decreases the risk of first variceal bleeding compared to endoscopic variceal ligation. It is associated with different adverse event profiles, highlighting its potential as the preferred first-line prophylactic therapy, especially in settings where resources are limited. This evidence supports a paradigm shift in global practice toward greater adoption of nonselective beta-blockers such as carvedilol for primary prophylaxis.