Meta-analysis: Efficacy of therapeutic regimens in ongoing variceal bleeding

Background and Study Aims: Variceal bleeding is a major cause of mortality in liver cirrhosis. Therapeutic options include medical (vasoconstrictive/v asoactive drugs) and endoscopic (sclerotherapy/ligation) treatments. Most s tudies evaluating acute esophageal bleeding have included patients with bot h ongoing and recent bleeding. Therefore therapeutic efficacy in ongoing bl eeding may not have been adequately determined in these studies. A meta-ana lysis was performed for two reasons: first to compare directly the various treatments in the case of ongoing bleeding, as this would not be accomplish ed by a single trial, and secondly, to determine the success rates of each treatment option based on a larger number of patients. Methods: An extensive Medline search identified 13 randomized controlled tr ials with precise statements of the number of patients with ongoing bleedin g and their clinical outcomes. All studies followed a similar design and a Q test excluded heterogeneity of the studies. Data were pooled and cumulati ve success rates were calculated. Results. Ligation appeared to be the most effective treatment (91.0%, 95% C I 82.4-96.3%); it was significantly more successful than vasoconstrictive t reatment (vasopressin/terlipressin 68.7%, 61.7-75.2%; P<0.002, chi-squared- test) or vasoactive treatment (somatostatin/octreotide, 75.9%, 68.1-82.6%; P<0.02) treatment, but was not statistically better than sclerotherapy (81. 1%, 71.7-88.4%). The latter therapy was not statistically superior to medic al treatment options. Calculations of estimated true effects, which take in to account the weight of each study, rendered similar results. Conclusion. Ligation is the most effective treatment option. No significant difference was found between the efficacy of sclerotherapy and treatment w ith somatostatin or octreotide.