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Endoscopy 2001; 33(9): 737-746
DOI: 10.1055/s-2001-16526
Original Article

© Georg Thieme Verlag Stuttgart · New York

Meta-Analysis: Efficacy of Therapeutic Regimens in Ongoing Variceal Bleeding

M. Gross1 , U. Schiemann1 , A. Mühlhöfer2 , W. G. Zoller2
  • 1 Klinikum der Universität München, Medizinische Poliklinik - Innenstadt, Germany
  • 2 Katharinenhospital, Stuttgart, Germany
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Publication History

Publication Date:
20 August 2001 (online)

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Background and Study Aims: Variceal bleeding is a major cause of mortality in liver cirrhosis. Therapeutic options include medical (vasoconstrictive/vasoactive drugs) and endoscopic (sclerotherapy/ligation) treatments. Most studies evaluating acute esophageal bleeding have included patients with both ongoing and recent bleeding. Therefore therapeutic efficacy in ongoing bleeding may not have been adequately determined in these studies. A meta-analysis was performed for two reasons: first to compare directly the various treatments in the case of ongoing bleeding, as this would not be accomplished 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 trials with precise statements of the number of patients with ongoing bleeding and their clinical outcomes. All studies followed a similar design and a Q test excluded heterogeneity of the studies. Data were pooled and cumulative success rates were calculated.

Results: Ligation appeared to be the most effective treatment (91.0 %, 95 % CI 82.4 - 96.3 %); it was significantly more successful than vasoconstrictive treatment (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 medical treatment options. Calculations of estimated true effects, which take into 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 with somatostatin or octreotide.

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M. Gross, M.D., Ph.D.

Medizinische Poliklinik - Innenstadt
Klinikum der Universität München

Pettenkoferstrasse 8 a
80336 München, Germany


Fax: + 49-89-51604187

Email: mgross@pk-i.med.uni-muenchen.de

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