Role of band ligation for secondary prophylaxis of variceal bleeding

World J Gastroenterol. 2018 Jul 14;24(26):2902-2914. doi: 10.3748/wjg.v24.i26.2902.

Abstract

Aim: To summarize and critically examine the role of band ligation in secondary prophylaxis of variceal bleeding in patients with cirrhosis.

Methods: A literature review was performed using the MEDLINE and PubMed databases. The search terms consisted of the words "endoscopic band ligation" OR "variceal band ligation" OR "ligation" AND "secondary prophylaxis" OR "secondary prevention" AND "variceal bleeding" OR "variceal hemorrhage" AND "liver cirrhosis". The data collected from relevant meta-analyses and from the most recent randomized studies that were not included in these meta-analyses were used to evaluate the role of endoscopic band ligation in an effort to demonstrate the most recent advances in the treatment of esophageal varices.

Results: This study included 11 meta-analyses published from 2002 to 2017 and 10 randomized trials published from 2010 to 2017 that evaluated the efficacy of band ligation in the secondary prophylaxis of variceal bleeding. Overall, the results proved that band ligation was superior to endoscopic sclerotherapy. Moreover, the use of β-blockers in combination with band ligation increased the treatment effectiveness, supporting the current recommendations for secondary prophylaxis of variceal bleeding. The use of transjugular intrahepatic portosystemic shunt was superior to combination therapy regarding rebleeding prophylaxis, with no difference in the survival rates; however, the results concerning the hepatic encephalopathy incidence were conflicting. Recent advances in the management of secondary prophylaxis of variceal bleeding have targeted a decrease in portal pressure based on the pathophysiological mechanisms of portal hypertension.

Conclusion: This review suggests that future research should be conducted to enhance current interventions and/or to develop innovative treatment options with improved clinical endpoints.

Keywords: Band ligation; Endoscopic therapy; Esophageal varices; Liver cirrhosis; Rebleeding; Secondary prophylaxis; Variceal bleeding; Variceal eradication.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / standards
  • Esophageal and Gastric Varices / etiology*
  • Esophageal and Gastric Varices / mortality
  • Esophagoscopy / methods
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / prevention & control*
  • Humans
  • Ligation / adverse effects
  • Ligation / methods
  • Liver Cirrhosis / complications*
  • Portasystemic Shunt, Transjugular Intrahepatic / adverse effects
  • Portasystemic Shunt, Transjugular Intrahepatic / methods
  • Practice Guidelines as Topic
  • Sclerotherapy / adverse effects
  • Sclerotherapy / methods
  • Secondary Prevention / methods*
  • Secondary Prevention / standards
  • Treatment Outcome

Substances

  • Adrenergic beta-Antagonists