Upper GI bleed: in patients with varices endoscopic ligation is more effective and safer than sclerotherapy.

Clinical bottom line (level 1a)

  1. Patients with bleeding oesophageal varices who receive endoscopic ligation compared sclerotherapy are less likely to rebleed (NNT = 7 at unknown) , die (NNT = 12 at unknown) , die from rebleeding (NNT = 15 at unknown) or develop oesophageal strictures (NNT = 10 at unknown) .
Laine and Cook: Annals of Internal Medicine 1995; 123: 280-287
Expires October 2002

The study

Systematic review of all randomised controlled trials of
  • Patients: bleeding oesophageal varices
  • Intervention: endoscopic ligation compared with sclerotherapy
  • Outcome: rebleeding, death, death due to bleeding, complications

 

Articles found in ?English using MEDline, SCISEARCH, 1983-1995 (search terms: varices, ligation, band ) and and searching reference lists of retrieved articles, abstracts, contacting manufacturers and investigators in the field.

Selection criteria: see above
Appraisal criteria: detailed in text by 2 independent investigators
Articles excluded if:

7 studies found, involving 547 patients (mean age 46 to 56; 99% with cirrhosis)
Studies were not found to be heterogeneous.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
rebleeding unknown 127/273
(46.5%)		 0.52
(0.37 to 0.74) 		7
(5 to 14)
death unknown 88/273
(32.2%)		 0.67
(0.46 to 0.98) 		12
(7 to 230)
death from rebleeding unknown 26/187
(13.9%)		 0.49
(0.24 to 0.996) 		15
(10 to 2100)
oesophageal strictures unknown 30/273
(10.99%)		 0.10
(0.03 to 0.29) 		10
(9 to 13)

Comments

  1. There was no clear difference in the rates of bacterial peritonitis or pulmonary infection between the two treatments.
  2. Patients who had ligation compared with sclerotherapy required 2 fewer sessions (95% CI 1 to 4) for variceal obliteration.

Citation

  1. Laine L, and Cook D: Endoscopic ligation compared with sclerotherapy for treatment of oesophageal variceal bleeding: a meta-analysis. Annals of Internal Medicine 1995; 123: 280-287
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer:

Clinical Question.
Patient bleeding oesophageal varices
Intervention or Exposure endoscopic ligation
Comparison sclerotherapy
Outcome death, rebleed, stricture