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

Abstract :

AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding., METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identified. Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account., RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment significantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% confidence interval (CI): 1.69-2.85, P < 0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was significantly lower for the combined treatment group (OR: 1.83, 95% CI: 1.16-2.90, P = 0.009), as well as overall mortality (OR: 1.43, 95% CI: 1.03-1.98, P = 0.03)., CONCLUSION: Combination therapy should thus be recommended as the first line treatment for secondary prophylaxis of oesophageal variceal bleeding.

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https://hal.univ-angers.fr/hal-03268563
Contributeur : Okina Université d'Angers <>
Soumis le : mercredi 23 juin 2021 - 12:11:42
Dernière modification le : vendredi 2 juillet 2021 - 14:23:31

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Natalie Funakoshi, Frederique Segalas-Largey, Yohan Duny, Frédéric Oberti, Jean-Christophe Valats, et al.. Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis. World Journal of Gastroenterology, Baishideng Publishing Group Co. Limited, 2010, 16 (47), pp.5982 - 5992. ⟨10.3748/wjg.v16.i47.5982⟩. ⟨hal-03268563⟩

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