Meta-analysis Of Primary Prevention Of Endoscopic Ligation Plus Non-selective ? Receptor Blockers In The Prevention Of Esophageal Varices Rupture And Bleeding

Objective: To compare endoscopic variceal ligation(EVL)plus non-selective ?-blockers(NSBB)with monotherapy for the prevention of esophageal varices in liver cirrhosis about effectiveness and safety in primary prevention.Methods: All qualified literatures with deadlines of December 12,2019 were collected from PUBMED,EMBASE,COCHRANE,Wanfang,China national Knowledge and China Biology medicine disc databases by computer.We collecte all Randomized controlled trial(RCTS)of the efficacy of endoscopic ligation and non-selective ?-blockers in the prevention of the first hemorrhage of esophageal varices in cirrhosis was conducted.Literature screening was based on strict inclusion ctiteria and exclusion criteria.The literature quality was evaluated by Cochrane risk assessment tool,and statistical analysis was performed using Stata 15.1software.The observational indicators of the study were indicators ofeffectiveness and safety,and summary effect amount were expressed using relative risk(RR)and 95% confidence interval(CI).Results: A total of 7 eligible RCT studies were included,with a total of 829 patients,including 456 patients in the single-use group(experimental group)and 373 patients in the EVL + NSBB combination group.The meta-analysis results showed that compared with the EVL-only group,the EVL + The combination of NSBB significantly reduced the bleeding rate of varicose veins(RR = 2.25,95% CI: 1.05-4.81 P = 0.037),and reduced the recurrence rate of esophageal varices(RR = 3.50,95% CI: 1.97-6.24 P = 0.00),The difference was statistically significant,both for all-cause mortality(RR = 0.84,95% CI:0.50-1.40 P = 0.494)and bleeding-related mortality(RR = 5.00,95% CI:0.24-102.35 P = 0.296 The difference was not statistically significant.Compared with the NSBB group alone,the combination of EVL + NSBB significantly reduced the varicose bleeding rate(RR = 2.01,95% CI: 1.14-3.53 P = 0.016),and the difference was statistically significant.There was no significant difference in all-cause mortality(RR = 1.21,95% CI:0.77-1.89 P = 0.401)and bleeding-related mortality(RR = 2.00,95% CI:0.19-21.56 P = 0.568).In addition,the EVL + NSBB combined group and the single EVL group(RR = 0.20,95% CI: 0.04-1.15 P = 0.072)and the single NSBB group(RR = 0.20,95% CI: 0.01-4.09 P = 0.296)had no significant difference in the incidence of serious adverse events.Conclusion: Endoscopic ligation and non-selective ?-blockers combination therapy is superior to monotherapy in primary prevention of esophageal varices rupture and bleeding in liver cirrhosis,and there is no difference in safety.