Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Export

@article{citeulike:3021410, abstract = {BACKGROUND: Combining endoscopic therapy and beta-blockers may improve outcomes in patients with cirrhosis and bleeding esophageal varices. PURPOSE: To assess whether a combination of endoscopic and drug therapy prevents overall and variceal rebleeding and improves survival better than either therapy alone. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and conference proceedings through 30 December 2007. STUDY SELECTION: Randomized trials comparing endoscopic plus beta-blocker therapy with either therapy alone, without language restrictions. DATA EXTRACTION: Two reviewers independently extracted data on interventions and the primary study outcomes of overall rebleeding and mortality. Metaregression and stratified analysis were used to explore heterogeneity. DATA SYNTHESIS: 23 trials (1860 patients) met inclusion criteria. Combination therapy reduced overall rebleeding more than endoscopic therapy alone (pooled relative risk, 0.68 [95\% CI, 0.52 to 0.89]; I(2) = 61\%) or beta-blocker therapy alone (pooled relative risk, 0.71 [CI, 0.59 to 0.86]; I(2) = 0\%). Combination therapy also reduced variceal rebleeding and variceal recurrence. Reduction in mortality from combination therapy did not statistically significantly differ from that from endoscopic (Peto odds ratio, 0.78 [CI, 0.58 to 1.07) or drug therapy (Peto odds ratio, 0.70 [CI, 0.46 to 1.06]). Effects were independent of the endoscopic procedure (injection sclerotherapy or banding). No trial-level variable associated with the effect was identified through metaregression or stratified analysis. LIMITATION: Statistically significant heterogeneity in trial quality and evidence for selective reporting and publication bias were found. CONCLUSION: A combination of endoscopic and drug therapy reduces overall and variceal rebleeding in cirrhosis more than either therapy alone.}, address = {Hospital Universitario Ram\'{o}n y Cajal, Madrid, Spain.}, author = {Gonzalez, R. and Zamora, J. and Gomez-Camarero, J. and Molinero, L. M. and Ba\~{n}ares, R. and Albillos, A.}, citeulike-article-id = {3021410}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/18626050}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=18626050}, day = {15}, issn = {1539-3704}, journal = {Annals of internal medicine}, keywords = {varices}, month = {July}, number = {2}, pages = {109--122}, posted-at = {2008-07-19 23:45:31}, priority = {2}, title = {Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/18626050}, volume = {149}, year = {2008} }

TY - JOUR ID - citeulike:3021410 L3 - citeulike-article-id:3021410 N2 - BACKGROUND: Combining endoscopic therapy and beta-blockers may improve outcomes in patients with cirrhosis and bleeding esophageal varices. PURPOSE: To assess whether a combination of endoscopic and drug therapy prevents overall and variceal rebleeding and improves survival better than either therapy alone. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and conference proceedings through 30 December 2007. STUDY SELECTION: Randomized trials comparing endoscopic plus beta-blocker therapy with either therapy alone, without language restrictions. DATA EXTRACTION: Two reviewers independently extracted data on interventions and the primary study outcomes of overall rebleeding and mortality. Metaregression and stratified analysis were used to explore heterogeneity. DATA SYNTHESIS: 23 trials (1860 patients) met inclusion criteria. Combination therapy reduced overall rebleeding more than endoscopic therapy alone (pooled relative risk, 0.68 [95% CI, 0.52 to 0.89]; I(2) = 61%) or beta-blocker therapy alone (pooled relative risk, 0.71 [CI, 0.59 to 0.86]; I(2) = 0%). Combination therapy also reduced variceal rebleeding and variceal recurrence. Reduction in mortality from combination therapy did not statistically significantly differ from that from endoscopic (Peto odds ratio, 0.78 [CI, 0.58 to 1.07) or drug therapy (Peto odds ratio, 0.70 [CI, 0.46 to 1.06]). Effects were independent of the endoscopic procedure (injection sclerotherapy or banding). No trial-level variable associated with the effect was identified through metaregression or stratified analysis. LIMITATION: Statistically significant heterogeneity in trial quality and evidence for selective reporting and publication bias were found. CONCLUSION: A combination of endoscopic and drug therapy reduces overall and variceal rebleeding in cirrhosis more than either therapy alone. IS - 2 JF - Annals of internal medicine SN - 1539-3704 AD - Hospital Universitario Ramón y Cajal, Madrid, Spain. EP - 122 TI - Meta-analysis: Combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. VL - 149 SP - 109 KW - varices AU - Gonzalez, R AU - Zamora, J AU - Gomez-Camarero, J AU - Molinero, LM AU - Bañares, R AU - Albillos, A PY - 2008/07/15/ UR - http://view.ncbi.nlm.nih.gov/pubmed/18626050 ER -