P1495 - Endoscopic Band Ligation versus Pharmacological Therapy for Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Yousaf Zafar, MD, MSCI¹, Khadija Alam, ², Ruqaiyya Raza, ³, Tayyaba Shahiq, ⁴, Adnan Zafar, MD⁵, Laila Manzoor, MD⁵, Shahryar Khan, MD, MSc⁶
1Cleveland Clinic Florida, Madison, MS; 2Department of medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan, Madison, MS; 3Department of medicine, Karachi Medical and Dental College, Karachi, Pakistan, Madison, MS; 4Department of Medicine, Baqai Medical University, Karachi, Pakistan, Madison, MS; 5Magnolia Regional Health Center, Madison, MS; 6The University of Kansas Health System, Kansas City, KS

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
29 th 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: 19 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.

Discussion: 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.


Figure: Figure 1A: Forest plot demonstrating the comparison between EBL and BBs for the primary prevention of GI bleed in patients with cirrhosis.
Figure 1B: Forest plot demonstrating the comparison between EBL and BBs for the primary prevention of all-cause mortality in patients with cirrhosis.


Figure: Figure 1C: Forest plot demonstrating the comparison between EBL and BBs for the primary prevention of bleed-related mortality in patients with cirrhosis.
Figure 1D: Forest plot demonstrating the comparison between EBL and BBs for the primary prevention of esophageal variceal bleed in patients with cirrhosis.

Disclosures:
Yousaf Zafar indicated no relevant financial relationships.
Khadija Alam indicated no relevant financial relationships.
Ruqaiyya Raza indicated no relevant financial relationships.
Tayyaba Shahiq indicated no relevant financial relationships.
Adnan Zafar indicated no relevant financial relationships.
Laila Manzoor indicated no relevant financial relationships.
Shahryar Khan indicated no relevant financial relationships.

Yousaf Zafar, MD, MSCI¹, Khadija Alam, ², Ruqaiyya Raza, ³, Tayyaba Shahiq, ⁴, Adnan Zafar, MD⁵, Laila Manzoor, MD⁵, Shahryar Khan, MD, MSc⁶. P1495 - Endoscopic Band Ligation versus Pharmacological Therapy for Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.