Endoscopic Ligation vs. Sclerotherapy For Bleeding Esophageal Varices
Clinical Question
Does endoscopic ligation of bleeding esophageal varices reduce the risk of
subsequent rebleeding and death compared with injection sclerotherapy?
Clinical Bottom Lines
- Endoscopic ligation of esophageal variceal bleeding, compared with
sclerotherapy, resulted in lower rates of re-bleeding, mortality, and
complications and the need for fewer endoscopic treatments, and should be
considered the treatment of choice.
The Evidence
| Ligation vs. sclerotherapy |
Odds Ratio (95%CI) |
| Rebleeding |
0.52 (0.37-0.74) |
| Mortality |
0.67 (0.46-0.98) |
| Complications |
0.48 (0.20-1.17) |
| Ligation vs sclerotherapy |
RR |
RRR |
ARR |
NNTT |
| Rebleeding |
0.67 |
33% |
0.15 |
6 |
| Mortality |
0.76 |
24% |
0.08 |
12 |
| Complications |
0.30 |
70% |
0.20 |
5 |
Comments
- This study was a meta-analysis. Data analysis and statistical testing was
rigorous.
- There is sufficient power to conclude that ligation is superior to
sclerosis in preventing rebleeding and reducing mortality. The confidence
interval for complications was wide and did not exclude an OR of 1. However,
there is still a trend favoring ligation in all aspects except for no difference
in the rate of pulmonary complications in the subgroup analysis.
APPRAISED BY: Patrick Sousa, MD
DATE: October 11, 1995
Endoscopic Ligation Compared with Sclerotherapy for Treatment of
Esophageal Variceal Bleeding; A Meta-Analysis. Laine and Cook. Ann Intern Med.
August 1995; 123:280-287.
