[Sclerotherapy versus ligation in hemorrhage caused by rupture of esophageal varices. Direct meta-analysis of randomized trials]

Gastroenterol Clin Biol. 1995 Nov;19(11):914-20.
[Article in French]


Objectives: To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included.

Methods: The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review.

Results: Endoscopic sclerotherapy compared to banding ligation significantly increased the rate of rebleeding (OR: 1.6; 95% IC: 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR: 1.3; 95% IC: 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR: 0.9; 95% IC: 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR: 2.5; 95% IC: 1.7-3.7), in those cases with a positive heterogeneity test.

Conclusions: This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.

Publication types

  • Clinical Trial
  • Comparative Study
  • English Abstract
  • Meta-Analysis
  • Randomized Controlled Trial

MeSH terms

  • Endoscopy / methods*
  • Esophageal and Gastric Varices / complications*
  • Esophageal and Gastric Varices / surgery
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / prevention & control*
  • Humans
  • Ligation
  • Liver Cirrhosis, Alcoholic / complications*
  • Postoperative Complications
  • Recurrence
  • Rupture, Spontaneous
  • Sclerotherapy / methods*