Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis

Sclerotherapy may be more effective than propranolol in the prevention of variceal rebleeding but have more adverse effects.

A systematic review including 9 RCTs with a total of 359 subjects treated with propranolol and 371 subjects treated with sclerotherapy was abstracted in DARE.

In the mean percentage of patients free of rebleeding no significant difference was found between treatments (OR 0.89 for sclerotherapy compared to propranolol, 95% CI 0.65 to 1.23, Peto) or mean percentage of patients free of death from bleeding (OR 0.75, 95% CI 0.52 to 1.08, Peto). Treatment with sclerotherapy was associated with a higher mean percentage of patients free of variceal rebleeding (OR 0.50, 95% CI 0.36 to 0.69, Peto), but a greater risk of adverse events (mean percentage of patients free of adverse events OR 3.1, 95% CI 2.1 to 4.5, Peto). There was no difference in survival between the treatments.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients and interventions).

Ədəbiyyat

1. Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T. Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis. J Hepatol 1997 Feb;26(2):312-24.