| Journal: | Annals of hepatology |
| Database: | PERIÓDICA |
| System number: | 000417073 |
| ISSN: | 1665-2681 |
| Authors: | Funakoshi, Natalie1 Duny, Yohan2 Valats, Jean-Christophe1 Segalas Largey, Frederique1 Flori, Nicolas1 Bismuth, Michael1 Daures, Jean-Pierre2 Blanc, Pierre1 |
| Institutions: | 1Centre Hospitalier Universitaire de Montpellier, Hopital Saint Eloi, Montpellier, Herault. Francia 2Centre Hospitalier Universitaire de Nîmes, Department of Statistics, Nimes, Gard. Francia |
| Year: | 2012 |
| Season: | May-Jun |
| Volumen: | 11 |
| Number: | 3 |
| Pages: | 369-383 |
| Country: | México |
| Language: | Inglés |
| Document type: | Artículo |
| Approach: | Analítico, descriptivo |
| English abstract | To perform an updated meta-analysis comparing β-blockers (BB) with endoscopic variceal banding ligation (EVBL) in the primary prophylaxis of esophageal variceal bleeding. Material and methods. Randomized controlled trials were identified through electronic databases, article reference lists and conference proceedings. Analysis was performed using both fixed-effect and random-effect models. Heterogeneity and publication bias were systematically taken into account. Main outcomes were variceal bleeding rates and all-cause mortality, calculated overall and at 6, 12, 18 and 24 months. Results. 19 randomized controlled trials were analyzed including a total of 1,483 patients. Overall bleeding rates were significantly lower for the EVBL group: odds ratio (OR) 2.06, 95% confidence interval (CI) [1.55-2.73], p < 0.0001, without evidence of publication bias. Bleeding rates were also significantly lower at 18 months (OR 2.20, 95% CI [1.04-4.60], P = 0.04), but publication bias was detected. When only high quality trials were taken into account, results for bleeding rates were no longer significant. No significant difference was found for either bleedingrelated mortality or for all-cause mortality overall or at 6, 12, 18 or 24 months. BB were associated with more frequent severe adverse events (OR 2.61, 95% CI 1.60-4.40, P < 0.0001) whereas fatal adverse events were more frequent with EVBL (OR 0.14, 95% CI 0.02-0.99, P = 0.05). Conclusion. EVBL appears to be superior to BB in preventing the first variceal bleed, although this finding may be biased as it was not confirmed by high quality trials. No difference was found for mortality. Current evidence is insufficient to recommend EVBL over BB as first-line therapy |
| Disciplines: | Medicina |
| Keyword: | Terapéutica y rehabilitación, Cirugía, Farmacología, Gastroenterología, Cirrosis hepática, Sangrado variceal, Hipertensión portal, Ligadura endoscópica, Beta bloqueadores |
| Keyword: | Gastroenterology, Therapeutics and rehabilitation, Surgery, Pharmacology, Liver cirrhosis, Variceal bleeding, Portal hypertension, Endoscopic clipping, Beta blockers |
| Full text: | Texto completo (Ver PDF) |
