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Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis

Shan Tian1, Ruixue Li2, Yingyun Guo1

  • 1Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, dongweiguo@whu.edu.cn.

Therapeutics and Clinical Risk Management
|February 19, 2019
PubMed

Insights

Carvedilol and endoscopic band ligation (EBL) show similar effectiveness in preventing variceal bleeding for patients with esophageal varices. Further large-scale trials are needed for definitive conclusions on these prophylactic treatments.

Area of Science:

  • Gastroenterology and Hepatology
  • Clinical Pharmacology
  • Interventional Endoscopy

Background:

  • Variceal hemorrhage is a critical determinant of mortality in portal hypertension.
  • Current guidelines advocate for endoscopic band ligation (EBL) or carvedilol for variceal bleeding prophylaxis.
  • Existing clinical trials comparing carvedilol and EBL have produced conflicting outcomes.

Purpose of the Study:

  • To conduct a meta-analysis of randomized controlled trials (RCTs).
  • To evaluate the comparative benefits and harms of carvedilol versus EBL for preventing variceal bleeding.
  • To synthesize evidence on efficacy and safety for patients with esophageal varices.

Main Methods:

  • Systematic literature search of major databases (PubMed, Embase, Medline, Cochrane Library) up to August 2018.
  • Inclusion of RCTs comparing carvedilol and EBL for variceal bleeding prophylaxis.
  • Meta-analysis of key outcomes: variceal bleeding, all-cause mortality, bleeding-related deaths, and adverse events.

Main Results:

  • Seven RCTs involving 703 patients were analyzed (359 carvedilol, 354 EBL).
  • No significant difference was found in variceal bleeding rates between carvedilol and EBL (RR=0.86, 95% CI=0.60-1.23).
  • Similar outcomes were observed for all-cause deaths, bleeding-related deaths, and adverse events, with no statistically significant differences.

Conclusions:

  • Carvedilol and EBL demonstrate comparable efficacy in the prophylaxis of variceal bleeding in patients with esophageal varices.
  • The current meta-analysis indicates no significant advantage of one treatment over the other regarding bleeding prevention or mortality.
  • Larger-scale, high-quality clinical trials are necessary to establish a definitive conclusion and guide clinical practice.
Abstract

Keywords:
carvedilolendoscopic band ligationportal hypertensionvariceal bleeding

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