Meta-analysis: efficacy of therapeutic regimens in ongoing variceal bleeding

Endoscopy. 2001 Sep;33(9):737-46. doi: 10.1055/s-2001-16526.

Abstract

Background and study aims: Variceal bleeding is a major cause of mortality in liver cirrhosis. Therapeutic options include medical (vasoconstrictive/vasoactive drugs) and endoscopic (sclerotherapy/ligation) treatments. Most studies evaluating acute esophageal bleeding have included patients with both ongoing and recent bleeding. Therefore therapeutic efficacy in ongoing bleeding may not have been adequately determined in these studies. A meta-analysis was performed for two reasons: first to compare directly the various treatments in the case of ongoing bleeding, as this would not be accomplished by a single trial, and secondly, to determine the success rates of each treatment option based on a larger number of patients.

Methods: An extensive Medline search identified 13 randomized controlled trials with precise statements of the number of patients with ongoing bleeding and their clinical outcomes. All studies followed a similar design and a Q test excluded heterogeneity of the studies. Data were pooled and cumulative success rates were calculated.

Results: Ligation appeared to be the most effective treatment (91.0 %, 95 % CI 82.4-96.3 %); it was significantly more successful than vasoconstrictive treatment (vasopressin/terlipressin 68.7 %, 61.7-75.2 %; P < 0.002, chi-squared-test) or vasoactive treatment (somatostatin/octreotide, 75.9 %, 68.1-82.6 %; P < 0.02) treatment, but was not statistically better than sclerotherapy (81.1 %, 71.7-88.4 %). The latter therapy was not statistically superior to medical treatment options. Calculations of estimated true effects, which take into account the weight of each study, rendered similar results.

Conclusion: Ligation is the most effective treatment option. No significant difference was found between the efficacy of sclerotherapy and treatment with somatostatin or octreotide.

Publication types

  • Clinical Trial
  • Comparative Study
  • Meta-Analysis
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Asian Continental Ancestry Group
  • Confidence Intervals
  • Endoscopy
  • Europe
  • Female
  • Hemorrhage / complications
  • Hemorrhage / therapy*
  • Humans
  • Ligation / instrumentation
  • Liver / blood supply
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / therapy*
  • Male
  • Middle Aged
  • North America
  • Prospective Studies
  • Sclerotherapy / instrumentation
  • Time Factors
  • Treatment Outcome
  • Varicose Veins / complications
  • Varicose Veins / therapy*