Systematic Reviews
Copyright ©The Author(s) 2018.
World J Gastroenterol. Jul 14, 2018; 24(26): 2902-2914
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2902
Table 1 Results from meta-analyses comparing band ligation with other interventions in terms of all-cause related rebleeding, variceal rebleeding, all-cause related mortality, bleeding related mortality and complication rates
Study (reference)Publication yearCountryMethodNumber of studiesNumber of patientsAll-cause related rebleeding RR or OR/CI/I2Variceal rebleedingRR or OR/CI /I2All-cause related mortalityRR or OR/CI /I2Bleeding related mortalityRR or OR/CI/I2ComplicationsRR or OR/CI/I2
Singh et al[16]2002United StatesEBL vs EST + EBL7453NR1.12/ 0.69-1.81/ NRNR1.1/ 0.70-1.74/ NR0.37/ 0.21-0.62/ NR
Karsan et al[22]2005United StatesEBL vs EST + EBL8520NR1.05/ 0.67-1.64/ NS0.99/ 0.68-1.44/ NSNRNR
1Gonzalez et al[15]2008Spain2Combination therapy vs EBL44040.62/ 0.44-0.87/ 40%NR0.79/ 0.44-1.43/ 54%NRNR
Cheung et al[17]2009CanadaEBL vs PT66980.96/ 0.73-1.30/ 62%NR/ NR/ 79%1.20/ 0.92-1.57/ 0NR0.90/ 0.70-1.15/ 0
EBL+PT vs EBL44040.57/ 0.31-1.08/ 60%0.38/ 0.19-0.76/ 00.90/ 0.41-1.98/ 45%3.4/ 1.4-8.2/ 74%
EBL+PT vs PT22790.76/ 0.56-1.03/ 00.58/ 0.40-0.85/ 00.94/ 0.54-1.63/ 31%NR
Ding et al[13]2009Chinaβ-blockers + ISMN vs EBL44760.94/ 0.64-1.38 71.50%NR0.81/ 0.61-1.08/ 00.76/ 0.31-1.42/ 38.90%1.26/ 0.93-1.70/ 42.70%
1Funakoshi et al[14]2010FranceEBL vs EBL + β-blockers32523.16/ 1.76-5.34/ 0NR1.78/ 0.92-3.43/ 0NRNR
Li et al[18]2011ChinaEBL vs β-blockers + ISMN66870.95/ 0.65-1.40/ NR0.89/ 0.53-1.49/ NR1.25/ 1.01-1.55/ NR1.16/ 0.68-1.97/ NRNR
Thiele et al[19]2012Denmark3EBL+PT vs monotherapy99550.68/ 0.54-0.85/ 1%0.67/ 0.54-0.84/00.89/ 0.65-1.21/ 00.52/ 0.27-0.99/ NR1.42/ 0.94-2.13/ 69%
Ko et al[21]2012South KoreaEBL + β-blockers vs β-blockers44090.78/ 0.58-1.04/ NR0.60/ 0.41-0.88/ NR1.21/ 0.88-1.65/ NR
Dai et al[20]2015ChinaEBL vs EST1412360.68/ 0.57-0.81/ 9.00%NR0.95/ 0.77-1.17/ 32.80%NR0.28/ 0.13-0.58/ 86.50%
Albillos et al[23]2017SpainEBL + β-blockers vs EBL44160.36/ 0.21-0.59/ NR0.52/ 0.25-1.11/ NR0.50/ 0.28-0.89/ NRNRNR
EBL + β-blockers vs β-blockers33891.0/ 0.68-1.47/ NR0.81/ 0.53-1.23/ NR1.19/ 0.76-1.87/ NR
Table 2 Characteristics of the included randomized trials
Study (reference)Publication yearCountryNumber of subjects
Monici et al[35]2010Brazil70
Luz et al[26]2011Brazil83
Santos et al[34]2011Brazil38
Lo et al[31]2013Taiwan118
Stanley et al[30]2014United Kingdom64
Chen et al[28]2016China96
Holster et al[32]2016Netherlands72
Mansour et al[27]2017Egypt120
Lv et al[33]2017China49
Hanif et al[29]2017Pakistan60
Table 3 Baseline characteristics of the patients included in the review
Study (reference)PatientsGender (M/F)Age (range or ± SD)CP class (A/B/C)Cirrhosis etiology (agent %)
Monici et al[35]EBL + EST: 3625/1147.8 (30-68)28/8/0Alcohol/virus/alcohol+virus/cryptogenic/autoimmune/PSC/PBC 12/13/3/5/2/1
EBL + MC: 3426/848.5 (22-71)29/5/0Alcohol/virus/alcohol+ virus/cryptogenic/autoimmune/PSC/PBC 8/11/3/9/1/2
Luz et al[26]EBL: 44NRNR2/22/20Alcohol/virus/secondary biliary cirrhosis/cryptogenic/PBC 43.2/43.2/9.1/2.3/2.3
EST: 39NRNR3/21/15Alcohol/virus/secondary biliary cirrhosis/cryptogenic/PBC 43.6/38.5/7.7/5.1/5.1
Santos et al[34]EBL: 2013/752 ± 12.60/4/16Alcohol/HCV/alcohol+HCV/other 30/30/15/25
CI: 1814/451 ± 8.20/3/15Alcohol/HCV/alcohol+HCV/other 39/33/6/22
Lo et al[31]EBL+ vasoconstrictors: 6049/1152.5 ± 14.418/32/10Alcohol/HBV/HCV/HBV+HCV/cryptogenic 40/22/30/3/5
EBL+PPIs: 5849/954.2 ± 9.715/24/19Alcohol/HBV/HCV/HBV+HCV/cryptogenic 38/29/26/3/2/2
Stanley et al[30]EBL: 3121/1049.6 ± 12.8711/28/25Alcohol/NAFLD/PBC/DICLD 91/5/3/2
Carvedilol: 3322/1151.4 ± 10.8
Chen et al[28]EBL: 4832/1656 ± 1019/29/0HBV/HCV/Alcohol/autoimmune/other 59/4/6/8/23
EST: 4831/1754 ± 1120/28/0HBV/HCV/alcohol/autoimmune/other 75/0/2/10/13
Holster et al[32]EBL+β-blockers: 3523/1254 (30-71)13/18/4Alcohol/HBV+HCV/alcohol + HBV+HCV/autoimmune liver+biliary disease/other 51/3/8/26/11
TIPS: 3718/1956 (37-75)13/19/5Alcohol/HBV+HCV/alcohol + HBV+HCV/autoimmune liver+biliary disease/other 35/19/8/24/14
Mansour et al[27]EBL: 6034/26NR8/20/32HCV/HBV/HCV+HBV 86.67/6.66/6.66
EBL + EST: 6044/16NR14/22/24HCV/HBV/HCV+HBV 86.67/6.66/6.66
Lv et al[33]EBL+propranolol: 2516/846 (38-56)10/14/1HBV/HCV/alcohol/AH/HBV+AH/cryptogenic 86.67/13.3/0
TIPS: 2413/1249 (46-62)9/13/2HBV/HCV/alcohol/AH/HBV+AH/cryptogenic 83/4/4/4/0/4
Hanif et al[29]EBL+ propranolol: 3025/556.30 ± 5.80NRNR
Propranolol: 3013/1757.63 ± 5.98NRNR
Table 4 Results of individual trials comparing band ligation with other interventions in terms of variceal obliteration, rebleeding and variceal recurrence
Study (reference)TreatmentMean sessions to obliterateRate of obliteration /time to obliterate (%)Rebleeding rate(%)Variceal recurrence rate
Endoscopic band ligation vs endoscopic sclerotherapy
Luz et al[26]EBLNR75 at 5 d25 at 5 dNR
EST84.6 at 5 d15.4 at 5 d
Mansour et al[27]EBL3.43 ± 0.67100 at 15.6 wk16.7026.7 at 3 mo 10 at 6 mo
EBL + EST2.22 ± 0.92100 at 8.64 wk13.3020 at 3 mo 10 at 6 mo
Chen et al[28]EBL3 ± 0.52514.60NR
EBL + EST3 ± 0.616.3035.40
Endoscopic band ligation vs β-blockers
Stanley et al[30]EBLNR6535.50NR
Carvedilol6836.40
Endoscopic band ligation + β-blockers vs β-blockers
Hanif et al[29]EBL + propranololNRNR10NR
Propranolol40
Endoscopic band ligation + PPIs vs endoscopic band ligation + vasoconstrictors
Lo et al[31]EBL + vasoconstrictorsNRNR1.7 at 6 d 8.3 at 6-42 dNR
EBL + PPIs1.7 at 6 d 8.6 at 6-42 d
Endoscopic band ligation + β-blockers vs TIPS
Holster et al[32]EBL + β-blockersNR71 at 2 yr26 at 2 yrNR
TIPS73 at 2 yr0 at 2 yr
Lv et al[33]EBL + propranololNRNR37 at 6 mo 45 at 12 mo 45 at 24 mo 52 at 30.4 moNR
TIPS5 at 6 mo 15 at 12 mo 20 at 24 mo 17 at 30.9 mo
Santos et al[34]EBL3.17 ± 1.1590 at 75.4 d033 at 14.6 mo
CI3 ± 1.3678 at 55.4 d1057 at 7.9 mo
Endoscopic band ligation + endoscopic sclerotherapy vs endoscopic band ligation + microwave coagulation
Monici et al[35]EBL + EST2.75 ± 1.9297.308.3027.7 at 9.5 mo 19.5 at 12 mo
EBL + MC2.38 ± 1.6397.10017.6 at 9.16 mo 17.5 at 12 mo
Table 5 Results of individual trials comparing band ligation with other interventions in terms of mortality
Study (reference)TreatmentMean hospitalization days(range or ± SD)Mortality rate(%)Follow up (range or ± SD)
Endoscopic band ligation vs endoscopic sclerotherapy
Luz et al[26]EBLNR13.605 d
EST7.705 d
Mansour et al[27]EBLNRNo difference6 mo
EBL + EST
Endoscopic band ligation vs endoscopic band ligation + endoscopic sclerotherapy
Chen et al[28]EBLNR2.106 mo
EBL + EST6.30
Endoscopic band ligation vs β-blockers
Stanley et al[30]EBLNR51.6026.3 mo
Carvedilol27.30
Endoscopic band ligation + β-blockers vs β-blockers
Hanif et al[29]EBL + propranololNRNR6 mo
Propranolol
Endoscopic band ligation + PPIs vs endoscopic band ligation + vasoconstrictors
Lo et al[31]EBL + vasoconstrictors9.4 ± 2.36.7 at 42 d42 d
EBL + PPIs8.8 ± 3.85.2 at 42 d
Endoscopic band ligation + β-blockers vs TIPS
Holster et al[32]EBL + β-blockers8.8 ± 5.420 at 2 yr23.4 mo
TIPS12.4 ± 11.222 at 2 yr
Lv et al[33]EBL + propranololNR12 at 6 mo 12 at 12 mo 16 at 24 mo 33 at 30.4 mo30.4 mo
TIPS16 at 6 mo 17 at 12 mo 27 at 24 mo 33 at 30.9 mo30.9 mo
Endoscopic band ligation vs cyanoacrylate injection
Santos et al[34]EBLNR55338 ± 189 d
CI56
Endoscopic band ligation + endoscopic sclerotherapy vs endoscopic band ligation + microwave coagulation
Monici et al[35]EBL + ESTNR5.5036.1 (15-53) mo
EBL + MC5.8833.6 (14-54) mo