Meta Analysis: None-selective Beta-blockers Alone Or In Combination With Either Endoscopic Ligation Or Isosorbide Mononitrate To Prevent Primary Bleeding Of Esophageal Varices In Cirrhosis

Aim: To evaluate the efficacy and safety of None-selective ?-blockers alone or separately combined endoscopic ligation or isosorbide mononitrate in preventing primary bleeding of esophageal varices in cirrhosis.Methods: Electronc and manual searches were combined to systematic review all eligible randomized trials in the PubMed,EBMBASE,Corchrane Library and Web of Science databases.Using Stata 12.0 software for statistical analysis.The outcome measures included morality,bleed-related deaths,first variceal bleed and adverse events.Result: A total of 17 studies with 1988 patients were included in the research.The effect of None-selective ?-blockers on variceal bleeding was significantly worse than endoscopic ligation(RR = 1.45,95% CI: 1.06-1.97,P = 0.02),both for hemorrhagic-related mortality(RR=1.48,95%CI :0.89-2.43,P=0.13)and all-cause mortality(RR=0.88,95%CI:0.73-1.06,P=0.19)were not statistically significant.Compared with isosorbide mononitrate,None-selective ?-blockers couldn't significantly reduce the rate of variceal bleeding(RR=0.43,95%CI:0.17-1.12,P=0.08),all-cause mortality(RR=0.80,95%CI:0.38-1.69,P=0.56)and hemorrhagic-related mortality(RR=0.80,95%CI:0.12-5.32,P=0.82).In addition,None-selective ?-blockers plus endoscopic ligation or plus isosorbide mononitrat were not significantly different from None-selective ?-blockers alone in reducing the rate of variceal bleeding,bleeding-related mortality,and all-cause mortality.Finally,the overall safety of individual and combined therapy is essentially the same.Conslusion: The safety of None-selective ?-blockers alone or in combination with isosorbide mononitrate or endoscopic ligation is acceptable,but there is no difference between the use of None-selective ?-blockers alone or combined use in reducing the first hemorrhage of esophageal varices and improving the prognosis.In addition,endoscopic ligation for the primary prevention of cirrhosis of esophageal variceal bleeding may be more advantages.There are also need high quality and large sample randomized controlled trials to confirm conclusion.