SCLEROTHERAPY VERSUS BANDING LIGATION FOR BLEEDING ESOPHAGEAL-VARICES- METAANALYSIS OF RANDOMIZED CLINICAL-TRIALS

Objectives. - To compare the advantages of endoscopic ligation and end oscopic sclerotherapy for bleeding esophageal varices, published rando mized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included. Methods. - The methodology, populati on, treatment and outcomes of each relevant trial were evaluated by du plicate independent review. Results. - Endoscopic sclerotherapy compar ed to banding ligation significantly increased the rare of rebleeding (OR : 1.6; 95 % IC : 1.1-2.3) without increasing early mortality compa red to endoscopic banding ligation (OR : 1.3; 95 % IC : 0.8-1.9). The rate of varice eradication associated with these two types of treatmen t was not different (OR : 0.9; 95 % IC : 0.6-1.3) but was obtained mor e quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerother apy (OR : 2.5; 95 % IC : 1.7-3.7), in those cases with a positive hete rogeneity rest. Conclusions. - This meta-analysis shows a lower morbid ity with endoscopic banding ligation in patients with variceal hemorrh age. The most important advantage of endoscopic banding ligation was t he reduction of the rate of rebleeding.