Four RCTs were included in the review (n=476 patients). Trials scored 5 or 6 points on the Jadad score. The duration of follow-up ranged from approximately eight to 25 months.
There was no statistically significant difference between beta-adrenergic blocker plus 5-isosorbide mononitrate and endoscopic band ligation in rates of re-bleeding (four RCTs, n=476 patients), bleeding-related mortality (three RCTs, n=379 patients), overall mortality (four RCTs, n=476 patients) or complications (four RCTs, n=476 patients). No patients in either group died as a result of complications.
Significant heterogeneity was found for re-bleeding (p=0.01). After exclusion of one trial in which the beta-adrenergic blocker plus 5-isosorbide mononitrate group had a higher percentage of patients with large varices than in the endoscopic band ligation group, heterogeneity was no longer significant (p=0.31) and results were unchanged. No significant heterogeneity was found for the other three outcomes.