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

Aliment Pharmacol Ther. 2009 Sep 15;30(6):577-88. doi: 10.1111/j.1365-2036.2009.04075.x. Epub 2009 Jun 25.


Background: Variable methods are available for secondary prevention after oesophageal variceal bleeding (EVB).

Aim: To compare band ligation (BL), pharmacotherapy (PT) and BL+PT for EVB secondary prevention.

Methods: A systematic search of databases, references and meeting abstracts was conducted for randomized trials of BL, PT or BL+PT. The outcomes were mortality, rebleeding and adverse events. A random-effects model was used for meta-analyses.

Results: Twelve trials were included (6 BL vs. PT, 4 BL+PT vs. BL, 2 BL+PT vs. PT). All trials used beta-blockers +/- isosorbide mononitrate (ISMN) as PT. Mortality was not significantly different among trials. Rebleeding was not significantly different for BL vs. PT (RR 1.00, 95% CI 0.73-1.37). BL reduced rebleeding compared with PT for trials with mean beta-blocker dose <80 mg/day (RR 0.67, 95% CI 0.49-0.91). There were nonsignificant differences in rebleeding for BL+PT vs. BL (RR 0.57, 95% CI 0.31-1.08) and BL+PT vs. PT (RR 0.76, 95% CI 0.56-1.03). There was no difference in adverse events between BL vs. PT, but was higher with BL+PT vs. BL.

Conclusion: Band ligation and PT alone are comparable for secondary prevention of rebleeding after EVB. Further trials with adequate PT dosing are required to determine the efficacy of combination BL+PT therapy.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Combined Modality Therapy / methods
  • Esophageal and Gastric Varices / drug therapy*
  • Gastrointestinal Hemorrhage / drug therapy*
  • Humans
  • Isosorbide Dinitrate / analogs & derivatives*
  • Isosorbide Dinitrate / therapeutic use
  • Ligation
  • Randomized Controlled Trials as Topic
  • Secondary Prevention*
  • Treatment Outcome
  • Vasodilator Agents


  • Adrenergic beta-Antagonists
  • Vasodilator Agents
  • Isosorbide Dinitrate
  • isosorbide-5-mononitrate