Variceal ligation plus nadolol compared with variceal ligation after bleeding. Multicenter randomized trial. Preliminary analysis

Peña, Joaquín de la; Rivero, Monserrat; Suárez, C García; Brullet, Enric; Campo, Rafael Del; Vergara, Mercedes; Hemandez, Eloy Sanchez; Lorente, José Luis Martín

doi:10.1016/s0016-5085(03)83701-0

Cited by 4 publications

(7 citation statements)

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“…25 Nine trials (described in 15 references) were included in our qualitative analyses (Table 1). [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] All authors were approached for additional data. Authors from two trials responded, 31,39 one of which supplied us with unpublished data.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices

Thiele¹,

Krag²,

Rohde³

et al. 2012

Aliment Pharmacol Ther

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Summary Background In patients with oesophageal varices, the combination of endoscopic variceal ligation (EVL) and medical therapy is recommended as standard of care for prevention of rebleeding. The results of previous meta‐analyses on this topic are equivocal. Aim To assess the effects of EVL plus medical therapy vs. monotherapy (EVL or medical therapy alone) for secondary prevention in oesophageal varices. Methods Electronic and manual searches were combined. The primary outcome measures were overall rebleeding (variceal and nonvariceal) and mortality. Random‐effects meta‐analyses were performed with subgroup, sensitivity, regression and sequential analyses to identify sources of intertrial heterogeneity and the robustness of the results. Results Nine randomised trials were included. In total, 442 patients were randomised to combination therapy and 513 to monotherapy. Combination therapy reduced rebleeding (RR = 0.68; 95% CI = 0.54–0.85; number needed to treat eight patients). The result was confirmed in sequential and regression analyses, but not when limiting the analysis to trials with adequate selection bias control. No effect on overall mortality was identified (RR = 0.89; 95% CI = 0.65–1.21). Combination therapy reduced bleeding‐related mortality (RR = 0.52; 95% CI 0.27–0.99; number needed to treat 33 patients) and the risk of rebleeding from oesophageal varices. Combination therapy increased the risk of serious adverse events in fixed, but not in random‐effects meta‐analyses. Conclusions The combination of endoscopic variceal ligation and medical therapy reduce the risk of rebleeding, but not overall mortality. Additional research is needed to determine why reduced rebleeding rates do not lead to reduced mortality.

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Section: Resultsmentioning

confidence: 99%

Meta‐analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices

Thiele¹,

Krag²,

Rohde³

et al. 2012

Aliment Pharmacol Ther

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“…After reviewing the titles and abstracts, 1166 were excluded for duplications and nonrelevance. Further 13 were excluded for the following reasons: editorial, 21, 22 case series, 23 incorrect intervention 24, 25 and preliminary results when updated study results were available 26–33 . Six studies were included for analysis of band ligation (BL) vs. pharmacotherapy (PT) 9–13, 34 .…”

Section: Resultsmentioning

confidence: 99%

“…Six studies were included for analysis of band ligation (BL) vs. pharmacotherapy (PT) 9–13, 34 . Of these, five were full articles and one was as an abstract for which the thesis manuscript was obtained 33 . Four studies were included for combination BL+PT vs. BL, 35–38 two of which were published as abstracts 37, 38 .…”

Section: Resultsmentioning

confidence: 99%

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Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices

Cheung

Zeman

Zanten

et al. 2009

Aliment Pharmacol Ther

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“…Another study compared VBL combined with nadolol and sucralfate with VBL alone, showing the superiority of combination therapy in preventing rebleeding [17]. De La Pena et al [18] presented the results of their trial that compared VBL and nadolol with VBL alone. First variceal bleeding was controlled with VBL (73%) or sclerotherapy (34%) with 5 days of intravenous somatostatin.…”

Section: Variceal Band Ligation With Nadolol Versus Variceal Ligationmentioning

confidence: 99%

Management of esophageal varices: An update from Digestive Disease Week and American Association for the Study of Liver Diseases 2003

Gawrieh

Saeian

2004

Curr Gastroenterol Rep

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Esophageal varices are a commonly encountered complication of cirrhosis. beta-blockers are a well-established cornerstone of the treatment of portal hypertension and primary and secondary prophylaxis for prevention of esophageal variceal bleeding. However, not all patients tolerate this type of therapy. Moreover, the exact role of esophageal variceal band ligation alone or in combination with beta-blocker therapy in the management of patients with esophageal varices remains to be defined. This summary report presents a number of recent studies addressing these important issues.

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Variceal ligation plus nadolol compared with variceal ligation after bleeding. Multicenter randomized trial. Preliminary analysis

Cited by 4 publications

References 0 publications

Meta‐analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices

Meta‐analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices

Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices

Management of esophageal varices: An update from Digestive Disease Week and American Association for the Study of Liver Diseases 2003

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