Therapeutic Effect Of Endoscopic Variceal Ligation And Endoscopic Variceal Ligation Combined With Devascularization Procedure For Esophageal Varices; A Meta-analysis

Objective To evaluate the therapeutic efficacy of endoscopicvariceal ligation and EVL combined with devascularization procedurefor esophageal varices in cirrhosis.Methods The correlated literaturesabout the therapeutic effect of endoscopic variceal ligation and EVLcombined with devascularization procedure for esophageal varices inliver cirrhosis was identified from CNKI full-text database,Wanfangdatabase,China Biological Medicine Disc and Pubmed from1998to2013.We used RevMan5.2for Meta-analysis. We use relative risk (RR)and95%confidence intervals (95%CI) to suggest the statistics treatmentefficacy. We use statistic Q to test heterogeneity between studies. We useMantel-Haenszel method (fixed effects model) when there were noheterogeneity, using Der Simonian-Laird method (random effectsmodel) when there were obvious heterogeneity, and analyzing thesources of heterogeneity, including subgroup analysis and sensitivityanalysis. Result We totally retrieved39articles, including full text andabstracts. There are37available full texts, including2duplicated articles.After excluding24non-randomized controlled trial class articles,3animal experiments articles,2splenectomy combined ligation articles,1stapling esophageal transection combined devascularization article and1 drug-related article,5relevant prospective randomized controlled trialswere included．Meta-analysis showed that combined group reduced therecurrence of esophageal varices rate (RR=7.34，95%CI=4.30～12.51，P<0.00001),and the rebleeding rate (RR=6.24，95%CI=3.19～12.18，P<0.00001), however,the complication rate was higher in combinedgroup （RR=0.15，95%CI=0.07～0.33，P<0.00001).Meanwhile, therewas no significant difference between these two groups in mortality.Conclusion This Meta-analysis compares EVL and combineddevascularization through4indicators. This four indicators are theincidence of complications, recurrence rate of esophageal varices, uppergastrointestinal rebleeding and mortality. EVL is relatively simpler andhas less trauma. Also, it has a lower incidence of postoperativecomplications. So EVL is suitable to those patients in poor state who cannot tolerate the surgery. However, the combined operation has a lowerrate of rebleeding and recurrence which suggests a better long-termeffect.