Endoscopic Variceal Ligation versus Sclerotherapy Variceal Ligation for Acute Esophageal Variceal Bleeding Patients with Liver Cirrhosis: A Systematic Review of the Chinese Language Literature_Chinese Journal of Evidence-Based Medicine

Authors：

ZHONG Lichun ¹ ,  JIA Hong ² , LI Changping ¹ , OU Santao ³ , PENG Yan ¹

1. Department of Gastroenterology, Luzhou Medical College, Luzhou 646000, China. 2. Department of commonality sanitation, Luzhou Medical College3. Department of Nephrology, Luzhou Medical College;

Corresponding author：

JIA Hong, Email: jhong_lz@163.com

Keywords：

Endoscopic variceal ligation; Endoscopic variceal sclerotherapy; Esophageal variceal bleeding; Systematic review; Randomized controlled trial

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Objective 　To evaluate the efficacy and safety of endoscopic variceal ligation (EVL) versus endoscopic variceal sclerotherapy (EVS) for acute esophageal variceal bleeding in patients with liver cirrhosis.
Methods 　We searched CBMdisc (1979 to 2006), CNKI (1994 to 2006) and VIP for randomized controlled trials (RCTs) and quasi-RCTs comparing EVL and EVS for acute esophageal variceal bleeding patients with liver cirrhosis. The methodogical quality of included trials was critically assessed and the data were extracted by two reviewers, working independently. The Cochrane Collaboration’s RevMan 4.2.7 software was used for meta-analysis.
Results 　Nine RCTs involving a total of 1371 patients were included: 688 in EVL group and 683 in EVS. The meta-analyses showed a significant reduction for mortality [RR 0.60, 95%CI (0.36, 0.98)], and non-significant reductions in complications, rebleeding and emergency hemostasis in the EVL group compared to the EVS group. EVS was non-significantly better than EVL for the rate of eradication varices and recurrent varices.
Conclusions 　For acute esophageal variceal bleeding in patients with liver cirrhosis, EVL has better effect and fewer complications than EVS. However, because the quality of included RCTs was poor, the strength of our conclusions was limited. Further high-quality RCTs are required.

Citation： ZHONG Lichun,JIA Hong,LI Changping,OU Santao,PENG Yan. Endoscopic Variceal Ligation versus Sclerotherapy Variceal Ligation for Acute Esophageal Variceal Bleeding Patients with Liver Cirrhosis: A Systematic Review of the Chinese Language Literature. Chinese Journal of Evidence-Based Medicine, 2007, 07(2): 135-141. doi: Copy

1.	Liu HY. Internal medicine.6th ed. Beijing: The people health publishing house, 2004: 440.
2.	Pan GZ, Cao SZ. Contemporary gastroenterology. Beijing: Science publishing house, 1994: 1515.
3.	Liang XY, Zhou WH. Evidence based medicine and hepatopathy clinical practice. Modern Practical Medicine, 2005, 17(2): 119-121.
4.	Li BQ, Zhang XJ, Ma LX, et al. A comparative study of esophageal varicosis treated by sclerotherapy or ligation and combination of ligation and sclerotherapy. Hebei Medical Journal, 2006, 28(10): 914-915.
5.	Liu DL, Huo JR, Wu XP, et al. Comparative Clinical Study of Ligation Versus Sclerotherapy in the Treatment of Bleeding Esophageal Varices. HUNAN MEDICAL JOURNAL, 1999, 16(2): 90-92.
6.	Liu YF, Sun YJ. A cinical study of endoscopic treatment methods in 99 cases of esophageal varices. Journal of Medical Science Yanbian University, 2003, 26(3): 193-196.
7.	Qiu XD, Gu GM, Shi JP, et al. Comparative Study of Endoscopic Variceal Ligation and Endoscopic Sclerotherapy in Treat- ment of Variceal Hemorrhage. Chinese Journal of Gastroenterology, 2000, 5(4): 226-228.
8.	Wang H, Li YY, Nie YQ, et al. Comparison of variceal band ligation with sclerotherapy for control of esophageal varices bleeding. Guangdong Medical Journal, 2002, 23(4): 370-372.
9.	Yang YL, Wang BM, Liu WT, et al. Emergent endoscopic therapy for esophageal and gastric variceal bleeding of hepatic cirrhosis. Clinical Focus, 2006, 21(12): 845-846.
10.	Zeng SQ, Lv RF, Zhao YK, et al. A comparative observation of esophageal varicosis treated by ligation, sclerotherapy or its combination. Journal of Southeast China Mational Defence Medical Science, 2006, 8(2): 99-101.
11.	Zhang YP, Li M. To investigate the clinical result of sclerotherapy, banding ligationand sclerotherapy plus banding ligation sequential treatment in severe as ophagealvaricealbleeding. Journal of Anhui Health Vocational & Technical College, 2004, 3(6): 35-36, 89.
12.	Zhou PH, Yao LQ, Gao WD, et al. Endoscopic therapy for the esophageal variceal bleeding. China Journal of Endoscopy, 2001,7(2): 14-17.
13.	Fan TY, Liu FC. Comparison between effects of ligation and sclerotherapy in treatment of esophageal variceal bleeding after liver cirrhosis:a meta-analysis. World Chinese Journal of Digestology, 2006, 14(17): 1704-1709.
14.	刘厚钰. 内科学. 第6版. 北京: 人民卫生出版社, 2004: 440.
15.	潘国宗, 曹世植. 现代胃肠病学. 北京: 科学出版社, 1994: 1515.
16.	Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology, 2001, 33(2):333-338.
17.	Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med, 1999, 340(13): 988-993.
18.	梁晓岳, 周文红. 循证医学与肝病临床实践. 现代实用医学, 2005, 17(2): 119-121.
19.	李炳庆, 张学军, 马立新, 等. 内镜下硬化治疗、套扎及硬化治疗加套扎治疗食管静脉曲张出血的对照研究. 河北医药, 2006, 28(10): 914-915.
20.	刘德良, 霍继荣, 吴小平, 等. 套扎与硬化治疗食管静脉曲张出血的临床对比研究. 湖南医学, 1999, 16(2): 90-92.
21.	刘忆非, 孙远杰. 内窥镜直视下止血治疗食道静脉曲张出血——附99例报告. 延边大学医学学报, 2003, 26(3): 193-196.
22.	邱夏地, 顾国妹, 施建平, 等. 内镜套扎术和硬化疗法治疗食管静脉曲张破裂出血的比较研究. 胃肠病学, 2000, 5(4): 226-228.
23.	王红, 李瑜元, 聂玉强, 等. 内镜下套扎与硬化治疗食管静脉曲张出血疗效比较. 广东医学, 2002, 23(4): 370-372.
24.	杨玉龙, 王邦茂, 刘文天, 等. 急诊内镜治疗肝硬化食管胃底静脉曲张出血的疗效观察. 临床荟萃, 2006, 21(12): 845-846.
25.	曾素琴, 吕仁发, 赵勇凯, 等. 食管静脉曲张内镜下套扎及硬化等联合治疗的比较观察. 东南国防医药, 2006, 8(2): 99-101.
26.	张焰平, 李敏. 内镜治疗重度食管静脉曲张破裂出血的临床研究. 安徽卫生职业技术学院学报, 2004, 3(6): 35-36, 89.
27.	周平红, 姚礼庆, 高卫东, 等. 内镜治疗食管静脉曲张破裂出血(附385例报告). 中国内镜杂志, 2001, 7(2): 14-17.
28.	Laine L, Cook D. Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis. Annals of Internal Medicine, 1995, 123(4): 280-287.
29.	Heresbach D,Jacquelinet C,Nouel O, et al. Sclerotherapy versus banding ligation for bleeding esophageal varices:meta analysis of randomized clinical trials. Gastroenterologie Cliniqueet Biologique, 1995, 19 (11): 914-920.
30.	Gross M, Schiemann U, Muhlhofer A, et al. Meta-analysis: efficacy of. therapeutic regimens in ongoing variceal bleeding. Endoscopy, 2001, 33(9): 737-746.
31.	范铁艳, 程留芳. 结扎和硬化疗法治疗肝硬化食管静脉曲张出血疗效比较的荟粹分析. 世界华人消化杂志, 2006, 14(17): 1704-1709.

1. Liu HY. Internal medicine.6th ed. Beijing: The people health publishing house, 2004: 440.
2. Pan GZ, Cao SZ. Contemporary gastroenterology. Beijing: Science publishing house, 1994: 1515.
3. Liang XY, Zhou WH. Evidence based medicine and hepatopathy clinical practice. Modern Practical Medicine, 2005, 17(2): 119-121.
4. Li BQ, Zhang XJ, Ma LX, et al. A comparative study of esophageal varicosis treated by sclerotherapy or ligation and combination of ligation and sclerotherapy. Hebei Medical Journal, 2006, 28(10): 914-915.
5. Liu DL, Huo JR, Wu XP, et al. Comparative Clinical Study of Ligation Versus Sclerotherapy in the Treatment of Bleeding Esophageal Varices. HUNAN MEDICAL JOURNAL, 1999, 16(2): 90-92.
6. Liu YF, Sun YJ. A cinical study of endoscopic treatment methods in 99 cases of esophageal varices. Journal of Medical Science Yanbian University, 2003, 26(3): 193-196.
7. Qiu XD, Gu GM, Shi JP, et al. Comparative Study of Endoscopic Variceal Ligation and Endoscopic Sclerotherapy in Treat- ment of Variceal Hemorrhage. Chinese Journal of Gastroenterology, 2000, 5(4): 226-228.
8. Wang H, Li YY, Nie YQ, et al. Comparison of variceal band ligation with sclerotherapy for control of esophageal varices bleeding. Guangdong Medical Journal, 2002, 23(4): 370-372.
9. Yang YL, Wang BM, Liu WT, et al. Emergent endoscopic therapy for esophageal and gastric variceal bleeding of hepatic cirrhosis. Clinical Focus, 2006, 21(12): 845-846.
10. Zeng SQ, Lv RF, Zhao YK, et al. A comparative observation of esophageal varicosis treated by ligation, sclerotherapy or its combination. Journal of Southeast China Mational Defence Medical Science, 2006, 8(2): 99-101.
11. Zhang YP, Li M. To investigate the clinical result of sclerotherapy, banding ligationand sclerotherapy plus banding ligation sequential treatment in severe as ophagealvaricealbleeding. Journal of Anhui Health Vocational & Technical College, 2004, 3(6): 35-36, 89.
12. Zhou PH, Yao LQ, Gao WD, et al. Endoscopic therapy for the esophageal variceal bleeding. China Journal of Endoscopy, 2001,7(2): 14-17.
13. Fan TY, Liu FC. Comparison between effects of ligation and sclerotherapy in treatment of esophageal variceal bleeding after liver cirrhosis:a meta-analysis. World Chinese Journal of Digestology, 2006, 14(17): 1704-1709.
14. 刘厚钰. 内科学. 第6版. 北京: 人民卫生出版社, 2004: 440.
15. 潘国宗, 曹世植. 现代胃肠病学. 北京: 科学出版社, 1994: 1515.
16. Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology, 2001, 33(2):333-338.
17. Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med, 1999, 340(13): 988-993.
18. 梁晓岳, 周文红. 循证医学与肝病临床实践. 现代实用医学, 2005, 17(2): 119-121.
19. 李炳庆, 张学军, 马立新, 等. 内镜下硬化治疗、套扎及硬化治疗加套扎治疗食管静脉曲张出血的对照研究. 河北医药, 2006, 28(10): 914-915.
20. 刘德良, 霍继荣, 吴小平, 等. 套扎与硬化治疗食管静脉曲张出血的临床对比研究. 湖南医学, 1999, 16(2): 90-92.
21. 刘忆非, 孙远杰. 内窥镜直视下止血治疗食道静脉曲张出血——附99例报告. 延边大学医学学报, 2003, 26(3): 193-196.
22. 邱夏地, 顾国妹, 施建平, 等. 内镜套扎术和硬化疗法治疗食管静脉曲张破裂出血的比较研究. 胃肠病学, 2000, 5(4): 226-228.
23. 王红, 李瑜元, 聂玉强, 等. 内镜下套扎与硬化治疗食管静脉曲张出血疗效比较. 广东医学, 2002, 23(4): 370-372.
24. 杨玉龙, 王邦茂, 刘文天, 等. 急诊内镜治疗肝硬化食管胃底静脉曲张出血的疗效观察. 临床荟萃, 2006, 21(12): 845-846.
25. 曾素琴, 吕仁发, 赵勇凯, 等. 食管静脉曲张内镜下套扎及硬化等联合治疗的比较观察. 东南国防医药, 2006, 8(2): 99-101.
26. 张焰平, 李敏. 内镜治疗重度食管静脉曲张破裂出血的临床研究. 安徽卫生职业技术学院学报, 2004, 3(6): 35-36, 89.
27. 周平红, 姚礼庆, 高卫东, 等. 内镜治疗食管静脉曲张破裂出血(附385例报告). 中国内镜杂志, 2001, 7(2): 14-17.
28. Laine L, Cook D. Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis. Annals of Internal Medicine, 1995, 123(4): 280-287.
29. Heresbach D,Jacquelinet C,Nouel O, et al. Sclerotherapy versus banding ligation for bleeding esophageal varices:meta analysis of randomized clinical trials. Gastroenterologie Cliniqueet Biologique, 1995, 19 (11): 914-920.
30. Gross M, Schiemann U, Muhlhofer A, et al. Meta-analysis: efficacy of. therapeutic regimens in ongoing variceal bleeding. Endoscopy, 2001, 33(9): 737-746.
31. 范铁艳, 程留芳. 结扎和硬化疗法治疗肝硬化食管静脉曲张出血疗效比较的荟粹分析. 世界华人消化杂志, 2006, 14(17): 1704-1709.

Chinese Journal of Evidence-Based Medicine

Endoscopic Variceal Ligation versus Sclerotherapy Variceal Ligation for Acute Esophageal Variceal Bleeding Patients with Liver Cirrhosis: A Systematic Review of the Chinese Language Literature

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