Endoscopic Variceal Ligation (EVL) Versus EVL Plus Drug in Prevention of Esophageal Variceal Rebleeding:A Meta-Analysis

Objective: To compare the therapeutic effect of endoscopic variceal ligation(EVL) and EVL plus drug in prevention of esophageal variceal rebleeding.Methods: Randomized clinical trials(RCTs) on EVL and EVL plus drug for the prevention of esophageal variceal rebleeding were searched,and only the results with Jadad score higher than 3 were evaluated with RevMan 5.0 software for odds ratio(OR) with 95% confidence intervals(95% CI).The publication bias was investigated with funnel plots.Results: Three trials matched the criteria were recruited including 270 cases with a follow-up from 16 to 21 months.There was significant difference in rates of rebleeding(OR = 0.29,95% CI = 0.16-0.54;P 0.01),rebleeding due to esophageal varices(OR = 0.36,95% CI = 0.18-0.97;P 0.01),therapy related adverse effects(OR = 3.69,95% CI = 1.54-8.82;P 0.01) between EVL and EVL plus drug; there was no significant difference in rates of overall mortality(OR = 0.56,95% CI = 0.30-1.06;P 0. 05) and rebleeding related mortality(OR = 0.45,95% CI = 0.16-1.30;P 0.05) between the two groups.Symmetric funnel plots showed there may be publication bias.Conclusion: EVL plus medicine shows higher efficacy for the prevention of esophageal variceal rebleeding than EVL.Though there was no significant difference in overall mortality,there is a trend towards lower bleeding-related mortality and overall mortality in EVL plus drug therapy.Thus EVL plus drug therapy can be used as the first choice for prophylaxis of re-bleeding of esophageal varices.