Journal article
Pharmacotherapy plus endoscopic intervention is more effective than pharmacotherapy or endoscopy alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized, controlled trials
Gastrointestinal endoscopy, Vol.70(4), pp.658-664
10/01/2009
DOI: 10.1016/j.gie.2009.02.029
PMID: 19643407
Abstract
Background: Previous clinical trials on the treatment of esophageal variceal bleeding yielded mixed results regarding the efficacy of endoscopic procedures compared with pharmacotherapy only.
Objective: To compare the efficacy of endoscopic procedures with that of pharmacotherapy in the prevention of mortality and rebleeding.
Design and Setting: A systematic literature review was performed to identify randomized, controlled trials of the efficacy of pharmacotherapy and endoscopic therapy. A meta-analysis was performed by using the Comprehensive MetaAnalysis software package, A 2-sided alpha error < .05 was considered statistically significant (P < .05).
Patients: Twenty-five clinical trials with a total of 2159 patients were eligible for meta-analysis.
Outcome Measurements: Relative risk (RR) with 95% confidence interval (CI) was computed for all-cause mortality mortality from rebleeding, all-cause rebleeding, and rebleeding caused by vat-ices.
Results: Pharmacotherapy was as effective as endoscopic procedures in preventing rebleeding (RR 1.067; 95% CI, 0.865-1.316; P = .546), variceal rebleeding (RR 1.143; 95% CI, 0.791-1.651; P = .476), all-cause mortality (RR 0.997; 95% CI, 0.827-1.202, P = .978), and mortality from rebleeding (RR 1.171; 95% CI, 0.816-1.679; P = .39). Pharmacotherapy combined with endoscopic procedures did not reduce all-cause mortality (RR 0.787; 95% CI, 0.587-1.054; P = .108) Or mortality caused by rebleeding (RR 0.786; 95% CI, 0.445-1.387; P = .405) compared with endoscopic procedures. However. combination therapy (endoscopic procedure plus pharmacotherapy) significantly reduced the incidence of all rebleeding (RR 0.623; 95% CI 0.523-0.741; P < .001) and variceal rebleeding (RR 0.601; 95% CI, 0.440-0.820; P < .001).
Limitations: Heterogeneity of patient population and different treatment protocols may have affected our meta-analysis.
Conclusion: Pharmacotherapy may be as effective as endoscopic therapy in reducing rebleeding rates and all-cause mortality Pharmacotherapy plus endoscopic intervention is more effective than endoscopic intervention alone. (Gastrointest Endosc 2009;70:658-64.)
Details
- Title: Subtitle
- Pharmacotherapy plus endoscopic intervention is more effective than pharmacotherapy or endoscopy alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized, controlled trials
- Creators
- Mamata Ravipati - Mercy St. Vincent Medical CenterSrikanth Katragadda - Mercy St. Vincent Medical CenterPaari Dominic Swaminathan - Mercy St. Vincent Medical CenterJanos Molnar - Mercy St. Vincent Medical CenterEdwin Zarling - Mercy St. Vincent Medical Center
- Resource Type
- Journal article
- Publication Details
- Gastrointestinal endoscopy, Vol.70(4), pp.658-664
- Publisher
- Elsevier
- DOI
- 10.1016/j.gie.2009.02.029
- PMID
- 19643407
- ISSN
- 0016-5107
- eISSN
- 1097-6779
- Number of pages
- 7
- Language
- English
- Date published
- 10/01/2009
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984366364302771
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