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Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis
Natalie Funakoshi, Frédérique Ségalas-Largey, Jean-Christophe Valats, Michael Bismuth, Pierre Blanc, Department of Hepato-gastroenterology B, Saint Eloi Hospital, University Hospital of Montpellier, 34295 Montpellier Cedex 5, France
Yohan Duny, Jean-Pierre Daurès, Department of Statistics, University Hospital of Nimes, place du Pr R. Debré, 30029 Nîmes Cedex 9, France
Frédéric Oberti, Department of Hepato-gastroenterology, University Hospital of Angers, 4 rue Larrey, 49933 Angers Cedex 9, France
Author contributions: Funakoshi N and Ségalas-Largey F were involved in acquisition of data, analysis and interpretation of data, and drafting of the manuscript; Oberti F was involved in acquisition, analysis and interpretation of data; Duny Y was involved in analysis and interpretation of data and statistical analysis; Valats JC and Bismuth M provided technical support and were involved in study supervision; Daurès JP was involved in study concept and design, statistical analysis and study supervision; Blanc P was involved in study concept and design, analysis and interpretation of data, critical revision of the manuscript and study supervision.
Correspondence to: Pierre Blanc, MD, PhD, Department of Hepato-gastroenterology B, Saint Eloi Hospital, University Hospital of Montpellier, 80 rue Augustin Fliche, 34295 Montpellier Cedex 5, France. firstname.lastname@example.org
Telephone: +33-4-67337077 Fax: +33-4-67337077
Received: June 29, 2010
Revised: September 7, 2010
Accepted: September 14, 2010
Published online: December 21, 2010
AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding.
METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identified. Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account.
RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment significantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% confidence interval (CI): 1.69-2.85, P < 0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was significantly lower for the combined treatment group (OR: 1.83, 95% CI: 1.16-2.90, P = 0.009), as well as overall mortality (OR: 1.43, 95% CI: 1.03-1.98, P = 0.03).
CONCLUSION: Combination therapy should thus be recommended as the first line treatment for secondary prophylaxis of oesophageal variceal bleeding.