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Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis

Authors Tian S, Li R, Guo Y, Jia X, Dong W

Received 2 November 2018

Accepted for publication 2 January 2019

Published 29 January 2019 Volume 2019:15 Pages 191—200

DOI https://doi.org/10.2147/TCRM.S193196

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang


Shan Tian,1,* Ruixue Li,2,* Yingyun Guo,1 Xuemei Jia,1 Weiguo Dong1

1Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China; 2Department of Gastroenterology, Renmin Hospital of Macheng City, Macheng, Hubei, People’s Republic of China

*These authors contributed equally to this work

Objective: Variceal hemorrhage is the primary driver of mortality in patients with portal hypertension. Recent guidelines recommended that patients with esophageal varices should receive endoscopic band ligation (EBL) or carvedilol as prophylaxis of variceal bleeding. Several clinical trials have compared carvedilol use with EBL intervention, yielding controversial results. The present study aimed to perform a meta-analysis of randomized controlled trials (RCTs) evaluating the benefits and harms of carvedilol vs EBL for the prevention of variceal bleeding.
Methods: Studies were searched on Pubmed, Embase, Medline, and Cochrane library databases up to August 2018. Main outcomes in selected studies (variceal bleeding, all-cause deaths, bleeding-related deaths, and adverse events) were pooled into a meta-analysis.
Results: Seven RCTs were identified in this meta-analysis, including a total of 703 patients. A total of 359 patients were randomized to carvedilol group and 354 were randomized to EBL group. No significant difference in variceal bleeding was observed between carvedilol use and EBL groups (relative ratio [RR] =0.86, 95% CI =0.60–1.23, I2=11%), without publication bias. No significant difference was found neither for all-cause deaths (RR =0.82, 95% CI =0.44–1.53, I2=66%) nor for bleeding-related deaths (RR =0.85, 95% CI =0.39–1.87, I2=42%) in four included studies. Moreover, no reduced trend was observed toward adverse events in carvedilol group compared with that in EBL group (RR =1.32, 95% CI =0.75–2.31, I2=81%).
Conclusion: There is no significant difference between carvedilol use and EBL intervention for the prophylaxis of variceal bleeding in patient with esophageal varices. Large-scale clinical trials are further needed to make a confirmed conclusion.

Keywords: carvedilol, endoscopic band ligation, variceal bleeding, portal hypertension
 

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