The Efficacy Of Sequential Therapy With Ligation And Sclerotherapy For The Treatment Of Esophageal Varices:A Meta-analysis

Objective:To compare the efficacy of Endoscopic Ligation combined with sequential Sclerotherapy with single Ligation and single Sclerotherapy in the treatment of cirrhotic esophageal varices by meta-analysis system.Methods:CNKI、 Wanfang Database,VIP database,CBM,Pub Med,Cochrane Library and Web of Science were searched by computer.All RCTS published between January 1995 and September 2021 comparing the efficacy of Ligation combined with sequential Sclerotherapy versus single Ligation and sequential therapy versus single Sclerotherapy in the treatment of cirrhotic esophageal varices were retrieved.Meta-analysis was performed using Revman5.3 software.Results:A total of 15 randomized controlled trials with 1283 subjects were selected.The results of meta-analysis were as follows: The total response rate in the single EVL group was lower than that in the EVLS group（RR 0.90,95%CI0.92-0.98 P=0.02）;The rebleeding rate in the single EVL group was significantly higher than that in the EVLS group（RR 1.88,95%CI 1.34-2.63 P=0.0003）.The postoperative recurrence rate of the single EVL group was higher than that of the EVLS group（RR 2.41,95%CI 1.75-3.31 P=0.00001）.There was no statistical difference in mortality,hemostasis rate and complication rate between the two groups.Therefore,the effect of EVLS is better than that of single EVL.The effective rate of single EIS group was lower than that of EVLS（RR 0.94,95%CI0.90 to 0.98 P=0.009）.The rebleeding rate was higher in the single EIS group than in the EVLS group（RR 2.21,95%CI 1.29-3.77 P =0.004）,and the complication rate was higher in the single EIS group than in the EVLS group（RR 2.38,95%CI 1.683.37 P = 0.00001）;There was no significant difference in mortality,hemostasis rate and recurrence rate between the two groups,so the efficacy of EVLS was better than that of single EIS.Conclusion:In the treatment of esophageal varices in cirrhosis,EVLS has more advantages than single EVL or single EIS,with high effective rate,low rebleeding rate,low recurrence rate,low complication rate and higher safety,so it is worthy of clinical application.