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Titolo:
A meta-analysis of endoscopic variceal ligation for primary prophylaxis ofesophageal variceal bleeding
Autore:
Imperiale, TF; Chalasani, N;
Indirizzi:
Regenstrief Inst Hlth Care, Indianapolis, IN 46202 USA Regenstrief Inst Hlth Care Indianapolis IN USA 46202 apolis, IN 46202 USA Indiana Univ, Sch Med, Richard L Roudebush VA Med Ctr, Dept Med,Div Gen Internal Med, Indianapolis, IN USA Indiana Univ Indianapolis IN USA Gen Internal Med, Indianapolis, IN USA Indiana Univ, Sch Med, Richard L Roudebush VA Med Ctr, Dept Med,Div Gastroenterol & Hepatol, Indianapolis, IN USA Indiana Univ Indianapolis IN USA enterol & Hepatol, Indianapolis, IN USA
Titolo Testata:
HEPATOLOGY
fascicolo: 4, volume: 33, anno: 2001,
pagine: 802 - 807
SICI:
0270-9139(200104)33:4<802:AMOEVL>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
CIRRHOTIC-PATIENTS; RANDOMIZED TRIAL; CLINICAL-TRIALS; SCLEROTHERAPY; METAANALYSIS; PROPRANOLOL; PREVENTION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Imperiale, TF Regenstrief Inst Hlth Care, 1050 Wishard Blvd, Indianapolis,IN 46202 USA Regenstrief Inst Hlth Care 1050 Wishard Blvd Indianapolis IN USA 46202
Citazione:
T.F. Imperiale e N. Chalasani, "A meta-analysis of endoscopic variceal ligation for primary prophylaxis ofesophageal variceal bleeding", HEPATOLOGY, 33(4), 2001, pp. 802-807

Abstract

Despite publication of several randomized trials of prophylactic variceal ligation, the effect on bleeding-related outcomes is unclear. We performed a mete-analysis of the trials, as identified by electronic database searching and cross-referencing. Both investigators independently applied inclusion and exclusion criteria, and abstracted data from each trial. Standard meta-analytic techniques were used to compute relative risks and the number needed to treat (NNT) for first variceal bleed, bleed-related mortality, and all-cause mortality. Among 601 patients in 5 homogeneous trials comparing prophylactic ligation with untreated controls, relative risks of first variceal bleed, bleed-related mortality, and all-cause mortality were 0.36 (0.26-0.50), 0.20 (0.11-0.39), and 0.55 (0.43-0.71), with respective NNTs of 4.1, 6.7, and 5.3, Among 283 subjects from 4 trials comparing ligation with beta -blocker therapy, the relative risk of first variceal bleed was 0.48 (0.24-0.96), with NNT of 13; however, there was no effect on either bleed-related mortality (relative risk [RR], 0.61; confidence interval [CI], 0.20-1.88) or all-cause mortality (RR, 0.95; CI, 0.56-1.62). In conclusion, compared with untreated controls, prophylactic ligation reduces the risks of variceal bleeding and mortality. Compared with beta -blockers, ligation reduces the risk for first variceal bleed but has no effect on mortality. Prophylactic ligation should be considered for patients with large esophageal varices who cannot tolerate beta -blockers. Subsequent research should further compare ligation and beta -blockers to determine the effect on mortality, andmeasure ligation's cost-effectiveness.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 12/07/20 alle ore 08:54:35