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Treatment of bleeding oesophageal varices: a meta-analysis
1Dept. of Gastroenterology, University of Milan, Italy.
Background:
Since some trials conducted over these last 15 years have not included enough patients, while others comparing the same therapies have produced conflicting results, the true efficacy of various treatments is poorly defined.
Aim:
The aim of the study was to critically review all randomized trials for acute variceal bleeding to verify the efficacy of therapies in terms of either control of bleeding or of short-term survival.
Methods:
Results of randomized trials were collected from Index Medicus and abstracts from gastroenterology and hepatology societies and compared. Major end-results were overall mortality and rate of bleeding control.
Results:
Control of bleeding--vasoactive (vasopressin, terlipressin, somatostatin) drugs were shown to be significantly better than placebo, H2 antagonists, or no treatment. Moreover, a weak trend in favour of somatostatin was found. Sclerotherapy was shown to be significantly better than conventional therapy. SHORT-TERM MORTALITY: Conventional meta-analysis showed a marginal improvement in short-term mortality when comparing vasoactive drugs with placebo, H2 blockers or no treatment at all.
Conclusion:
Vasoactive therapy is more effective than conservative measures in controlling bleeding, sclerotherapy being even more so. Moreover, sclerotherapy shows a significant improvement in short-term survival compared with conventional therapy.