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Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis.

Abstract：

BACKGROUND:Combining endoscopic therapy and beta-blockers may improve outcomes in patients with cirrhosis and bleeding esophageal varices. PURPOSE:To assess whether a combination of endoscopic and drug therapy prevents overall and variceal rebleeding and improves survival better than either therapy alone. DATA SOURCES:MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and conference proceedings through 30 December 2007. STUDY SELECTION:Randomized trials comparing endoscopic plus beta-blocker therapy with either therapy alone, without language restrictions. DATA EXTRACTION:Two reviewers independently extracted data on interventions and the primary study outcomes of overall rebleeding and mortality. Metaregression and stratified analysis were used to explore heterogeneity. DATA SYNTHESIS:23 trials (1860 patients) met inclusion criteria. Combination therapy reduced overall rebleeding more than endoscopic therapy alone (pooled relative risk, 0.68 [95% CI, 0.52 to 0.89]; I(2) = 61%) or beta-blocker therapy alone (pooled relative risk, 0.71 [CI, 0.59 to 0.86]; I(2) = 0%). Combination therapy also reduced variceal rebleeding and variceal recurrence. Reduction in mortality from combination therapy did not statistically significantly differ from that from endoscopic (Peto odds ratio, 0.78 [CI, 0.58 to 1.07) or drug therapy (Peto odds ratio, 0.70 [CI, 0.46 to 1.06]). Effects were independent of the endoscopic procedure (injection sclerotherapy or banding). No trial-level variable associated with the effect was identified through metaregression or stratified analysis. LIMITATION:Statistically significant heterogeneity in trial quality and evidence for selective reporting and publication bias were found. CONCLUSION:A combination of endoscopic and drug therapy reduces overall and variceal rebleeding in cirrhosis more than either therapy alone.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Gonzalez R,Zamora J,Gomez-Camarero J,Molinero LM,Bañares R,Albillos A

doi

10.7326/0003-4819-149-2-200807150-00007

subject

Has Abstract

pub_date

2008-07-15 00:00:00

pages

109-22

issue

eissn

0003-4819

issn

1539-3704

pii

149/2/109

journal_volume

149

pub_type

杂志文章,meta分析

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Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis.