Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis

Figures & data

Figure 1 Study selection flow diagram.

Table 1 Clinical features of patients in the included studies

Author year	Group	Study period	Patients (n)	Age (years)	Men vs women	Ascites (n)	Child– Pugh class	Interventions	Follow-up (months)
Elrahim et al,^Citation18 2018	C EBL	2015–5 to 2016–6	84 88	51.2±11.0 50.6±5.9	34:66 38:62	26 44	30/28/42 20/24/56	6.25 mg/d initiation Up to 12.5–50 mg/d EBL/2 weeks until eradication of varices	12 12
Stanley et al,^Citation20 2014	C EBL	2006–6 to 2012–6	33 31	51.4±10.8 49.6±12.87	22:11 21:10	12 12	9 (7.0–10.5) 9 (8.0–11.0)	6.25 mg/d for 1 week, then increased to 12.5 mg/d EBL at 1 week, then 2 weekly	26.3 (10.2–46.6) 26.3 (10.2–46.6)
Shah et al,^Citation17 2014	C EBL	2007–5 to 2011–9	82 86	48.3±11.3 47.2±13.2	59:23 63:23	33 32	37/35/10 37/37/12	6.25 mg/d initiation then increased to 6.25 mg twice a day EBL/3 weeks until eradication of varices	13.2±11.7 13.4±12.4
Tripathi et al,^Citation21 2009	C EBL	2000–4 to 2006–5	77 75	54.2±9.4 54.5±11.1	54:23 55:20	49 53	38/24/38 35/25/40	6.25 mg/d initiation, then increased to 12.5 mg/d EBL/2 weeks until eradication of varices	26.2±22.1 25.5±21.9
Elnadry,^Citation13 2010	C EBL	2008–2 to 2009–3	20 20	50.1±6.2 51.5±8.1	11:9 13:7	NR NR	12/4/4 8/4/8	12.5 mg increased after 2 weeks to reach 25 mg daily NR	12 12
Ahmad et al,^Citation19 2012	C EBL	2008–12 to 2011–9	25 25	NR NR	NR NR	NR NR	9/7/9 9/6/10	6.25 mg/d for 1–2 weeks, increased to 12.5 mg/d EBL/2–4 weeks until eradication of varices	12 12
Reiberger et al,^Citation16 2013	C EBL	2008–2012	38 29	55±11 50±14	28:10 23:6	4 5	26/10/2 16/11/2	6.25 mg/d and increased to 25 mg/d EBL/2–4 weeks until eradication of varices	24 24

Abbreviations: C, carvedilol; EBL, endoscopic band ligation; NR, not reported; mg/d, mg/day.

Figure 2 Risk of bias.

Notes: (A) Risk of bias graph. (B) Risk of bias summary.

Figure 3 Fixed-effect model of variceal bleeding.

Notes: (A) Forest plots for carvedilol use vs EBL for prophylaxis of variceal bleeding. (B) Forest plots for carvedilol use vs EBL for primary prevention.
Abbreviation: EBL, endoscopic band ligation.

Figure 4 Funnel plot of carvedilol use vs EBL.

Notes: (A) For first and second prophylaxis of variceal bleeding. (B) For first prophylaxis of variceal bleeding.
Abbreviations: EBL, endoscopic band ligation; RR, risk ratio.

Figure 5 Carvedilol vs EBL for prophylaxis.

Notes: (A) All-cause deaths. (B) Bleeding-related deaths.
Abbreviation: EBL, endoscopic band ligation.

Figure 6 Forest plots of adverse events.

Notes: (A) Five studies. (B) Four studies.
Abbreviation: EBL, endoscopic band ligation.

Table 2 Outcomes reported in the included studies

Author, year	Group	Variceal bleeding (n/N)	All-cause mortality (n/N)	Bleeding-related mortality (n/N)	Adverse events (n/N)
Abd Elrahim et al,^Citation18 2018	C	13/84	NR	NR	12/84
	EBL	9/88	NR	NR	5/84
Stanley et al,^Citation20 2014	C	12/33	9/33	5/33	19/33
	EBL	11/31	16/31	1/31	18/31
Shah et al,^Citation17 2014	C	7/82	16/82	4/82	50/82
	EBL	6/86	11/86	4/86	75/86
Tripathi et al,^Citation21 2009	C	7/77	20/77	2/77	10/77
	EBL	14/75	16/75	2/75	6/75
Elnadry et al,^Citation13 2010	C	2/20	NR	NR	13/20
	EBL	2/20	NR	NR	5/20
Ahmad et al,^Citation19 2012	C	2/25	NR	NR	NR
	EBL	3/25	NR	NR	NR
Reiberger et al,^Citation16 2013	C	3/38	4/38	1/38	NR
	EBL	7/29	9/29	5/29	NR

Abbreviations: C, carvedilol; EBL, endoscopic band ligation; NR, not reported.

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