Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

Abstract

Objective: To evaluate the efficacy and safety of endoscopic variceal ligation + endoscopic injection sclerotherapy (EVL+EIS) to control acute variceal bleeding (AVB).Methods: Online databases, including Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) disc, VIP, and Wanfang, were searched to identify the studies comparing the differences between EVB+EIS and EVB, EIS from the inception of the databases up to December 30, 2020. STATA 13.0 was used for the meta-analysis.Results: A total of eight studies involving 595 patients (317 patients in the EVL group and 278 patients in the EVL+EIS group) were included. The results of the meta-analysis did not reveal any statistically significant differences in the efficacy of acute bleeding control (P = 0.981), overall rebleeding (P = 0.415), variceal eradication (P = 0.960), and overall mortality (P = 0.314), but a significant difference was noted in the overall complications (P = 0.01).Conclusion: EVL is superior to the combination of EVL and EIS in safety, while no statistically significant differences were detected in efficacy. Further studies should be designed with a large sample size, multiple centers, and randomized controlled trials to assess both clinical interventions.

Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

“…Prior to PSM, our study showed that patients treated with EVL plus EIS had significantly less varicose recurrence and rebleeding than patients treated with EVL alone, whether at 6-, 12-, or 18-month follow-up. Our results agree with Mansour et al and Wang et al (2,10,14,15). Compared with EVL alone, the EVL plus EIS group had a significant advantage in variceal recurrence and rebleeding for the following principal reasons.…”

“…The advantages of our procedure are as follows: (1) the transparent cap is still present at the tip of the lens after EVL, which can fix the varicose vein and facilitate sclerotherapy and can also be used for compression if there is leakage; (2) performing EVL followed by EIS can also reduce the risk of bleeding after ligation of the thick varicose vein; (3) performing EVL earlier can reduce the pressure in the varicose vein and create conditions for subsequent sclerotherapy (less sclerosing agent, long sclerosing agent dwell time); and (4) the procedure does not require special skills and equipment. But, at present, there are still controversies about the efficacy and adverse events of EVL plus EIS and EVL alone for esophageal varicose (2,10,14,15). A meta-analysis discovered that EVL is superior to the combination of EVL and EIS in safety, while no significant differences were found in efficacy (2).…”

“…But, at present, there are still controversies about the efficacy and adverse events of EVL plus EIS and EVL alone for esophageal varicose (2,10,14,15). A meta-analysis discovered that EVL is superior to the combination of EVL and EIS in safety, while no significant differences were found in efficacy (2). However, some studies support that the combination of EVL and EIS is better than EVL alone (10,14,15).…”

“…Esophageal variceal bleeding (EVB) is one of the most severe adverse events of liver cirrhosis (1). Seven percent of patients with liver cirrhosis develop the symptom of esophagogastric fundic varices each year (2). Patients with cirrhosis who are not treated prophylactically have a high risk of rebleeding within 1 year and a mortality rate of approximately 15%-20% within 6 weeks (3).…”

Expert consensus on emergency procedures for portal hypertension bleeding (2022)

“…Some studies suggest that the combined therapy reduces varicose vein elimination time, treatment time, rebleeding, and complication rates compared with EVL alone. 39 However, there are also studies that demonstrate no reduction in rebleeding and mortality rates, but an increase in complications, such as esophageal stricture 40 ; therefore, further research is needed.…”