Endoscopic Variceal Ligation Combined With Argon Plasma Coagulation Versus Ligation Alone For The Secondary Prophylaxis Of Variceal Bleeding:A Systematic Review And Meta-analysis

Background and Aims:Endoscopic variceal ligation is often recommended as an effective method for treatment of esophageal varices,despite the important tendency of variceal recurrence.Recent studies indicate that combining endoscopic variceal ligation with argon plasma coagulation may be a more effective therapy than ligation alone.In order to investigate these findings,we conducted a systematic review and meta-analysis to compare the safety and efficacy of endoscopic variceal ligation combined with argon plasma coagulation versus ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage.Methods: All studies were searched through Pub Med,Cochrane Library,and Science Direct.The outcome measures were relative risk or risk difference with 95% confidence intervals for dichotomous data and standardized mean difference for continuous data.Heterogeneity was calculated using the chi-squared and I-squared test.Results: Two investigators independently identified four randomized controlled trials included in the research.The variceal recurrence rate was significantly lower in the combined therapy group(RR=0.19,95% CI:0.09–0.41,P=0.000).The bleeding recurrence and mortalities in the two groups had no significant differences(RR=0.29,95% CI:0.08–1.04,P=0.058;RD= –0.02,95% CI=–0.08–0.04,P=0.576 respectively).Though the pyrexia incidence rate was significantly higher in the combined group(RR=3.42,95% CI:1.56–7.48,P=0.002),there was intertrial heterogeneity(I~2 = 52.5%,P = 0.097).Conclusions: Endoscopic variceal ligation combined with argon plasma coagulation is superior to ligation alone for endoscopic variceal recurrence without severe adverse events in secondary prophylaxis against esophageal variceal bleeding.More high-quality studies are needed to strengthen this conclusion.