Carvedilol vs endoscopic variceal ligation for primary and secondary prevention of variceal bleeding: Systematic review and meta-analysis

Table 3 Summary of findings for the main comparison

Outcomes	Relative effect	Participants	Quality of the evidence	Comments
	(95%CI)	(studies)	(GRADE)
Variceal bleed in primary prevention (Grade I)	RR 0.38	250	++−−	Benefit for Carvedilol group
	(0.15-0.93)	(1 Study)	low
Variceal bleed in primary prevention (Grade II)	RR 0.92	492	+++−
	(0.42-2.41)	(3 Studies)	moderate
All-cause mortality in primary prevention	RR 1.10	320	++++
	(0.76-1.58)	(2 Studies)	high
Bleeding-related mortality in primary prevention	RR 1.02	320	++++
	(0.34-3.10)	(2 Studies)	high
Side effect of treatment in primary prevention	RR 4.18	276	+++−	Benefit for EVL group
	(2.19-7.95)	(2 Studies)	moderate
Compliance in primary prevention	RR 0.90	122	+++−
	(0.73-1.11)	(2 Studies)	low
Rebleeding events in secondary prevention	RR 1.10	230	++−−
	(0.75-1.61)	(3 Studies)	low
All-cause mortality in secondary prevention	RR 0.51	230	++−−	Benefit for Carvedilol group
	(0.33-0.79)	(3 Studies)	low

GRADE: Grading of Recommendations, Assessment, Development and Evaluation; Patient or population: Portal hypertension or cirrhosis patients; Comparison: Endoscopic variceal ligation; Settings: Secondary or tertiary hospital; Intervention: Carvedilol. GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect; Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; Very low quality: We are very uncertain about the estimate.