S2348 Endoscopic Band Ligation Versus Pharmacological Therapy for Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Variceal hemorrhage is one of the most severe complications of portal hypertension in liver cirrhosis with up to one-third of mortality rate. Current studies show conflicting evidence between the use of endoscopic band ligation (EBL) and pharmacological treatment as the first line of therapy for primary prophylaxis of esophageal variceal bleed in cirrhotic patients. The objective of the study was to compare and evaluate the efficacy of EBL and beta blockers (BBs) for the primary prevention of first variceal bleed in patients with cirrhosis. Methods: A systematic search of databases including PubMed and Google Scholar was done from inception till 29th May 2025 for relevant literature. The random-effects model was used to calculate the risk ratio (RR) for dichotomous outcomes along with their corresponding 95% confidence intervals (CI). Results: Nineteen RCTs involving a total of 2,371 patients with cirrhosis, who were randomized to either the EBL arm (n = 1,125) or the BBs arm (n = 1,136), were included. Our findings reported no statistically significant difference between EBL and BBs for the primary prevention of GI bleeding (RR = 0.81, 95% CI [0.65, 1.02]), all-cause mortality (RR = 1.02, 95% CI [0.86, 1.21]) and mortality due to bleeding (RR = 0.72, 95% CI [0.47, 1.09]). In contrast, EBL therapy (RR = 0.71, 95% CI [0.54, 0.94]) was more effective in preventing variceal bleeding compared to BBs. Conclusion: Our meta-analysis suggests that both EBL and BBs are equally effective in the primary prevention of GI bleeding, all-cause mortality, and mortality due to bleeding in patients with cirrhosis. However, EBL therapy is more effective in preventing variceal bleeding in this patient population. Further research is needed to further confirm our findings.