{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T04:18:17Z","timestamp":1782879497954,"version":"3.54.5"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T00:00:00Z","timestamp":1503705600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T00:00:00Z","timestamp":1503705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:p>Endoscopic variceal ligation plus beta\u2010blockers (EVL+BB) is currently recommended for variceal rebleeding prophylaxis, a recommendation that extends to all patients with cirrhosis with previous variceal bleeding irrespective of prognostic stage. Individualizing patient care is relevant, and in published studies on variceal rebleeding prophylaxis, there is a lack of information regarding response to therapy by prognostic stage. This study aimed at comparing EVL plus BB with monotherapy (EVL or BB) on all\u2010source rebleeding and mortality in patients with cirrhosis and previous variceal bleeding stratified by cirrhosis severity (Child A versus B\/C) by means of individual time\u2010to\u2010event patient data meta\u2010analysis from randomized controlled trials. The study used individual data on 389 patients from three trials comparing EVL plus BB versus BB and 416 patients from four trials comparing EVL plus BB versus EVL. Compared with BB alone, EVL plus BB reduced overall rebleeding in Child A (incidence rate ratio 0.40; 95% confidence interval, 0.18\u20100.89; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.025) but not in Child B\/C, without differences in mortality. The effect of EVL on rebleeding was different according to Child (<jats:italic toggle=\"yes\">P<\/jats:italic> for interaction &lt;0.001). Conversely, compared with EVL, EVL plus BB reduced rebleeding in both Child A and B\/C, with a significant reduction in mortality in Child B\/C (incidence rate ratio 0.46; 95% confidence interval, 0.25\u20100.85; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.013). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Outcomes of therapies to prevent variceal rebleeding differ depending on cirrhosis severity: in patients with preserved liver function (Child A), combination therapy is recommended because it is more effective in preventing rebleeding, without modifying survival, while in patients with advanced liver failure (Child B\/C), EVL alone carries an increased risk of rebleeding and death compared with combination therapy, underlining that BB is the key element of combination therapy. (H<jats:sc>epatology<\/jats:sc> 2017;66:1219\u20101231).<\/jats:p>","DOI":"10.1002\/hep.29267","type":"journal-article","created":{"date-parts":[[2017,5,25]],"date-time":"2017-05-25T13:20:20Z","timestamp":1495718420000},"page":"1219-1231","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":100,"title":["Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta\u2010analysis"],"prefix":"10.1097","volume":"66","author":[{"given":"Agust\u00edn","family":"Albillos","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Hospital Universitario Ram\u00f3n y Cajal, University of Alcal\u00e1, IRYCIS,Madrid,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Zamora","sequence":"additional","affiliation":[{"name":"Clinical Biostatistics Unit,Hospital Universitario Ram\u00f3n y Cajal, Universidad de Alcal\u00e1, IRYCIS,Madrid,Spain"},{"name":"Barts and the London School of Medicine and Dentistry,Queen Mary University of London,London,UK"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Hospital Universitario Ram\u00f3n y Cajal, University of Alcal\u00e1, IRYCIS,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Arroyo","sequence":"additional","affiliation":[{"name":"Clinical Biostatistics Unit,Hospital Universitario Ram\u00f3n y Cajal, Universidad de Alcal\u00e1, IRYCIS,Madrid,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Medical College\/Hospital,Rahim Yar Khan,Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquin","family":"De\u2010la\u2010Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Hospital Universitario Marqu\u00e9s de Valdecilla,Santander,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan\u2010Carlos","family":"Garcia\u2010Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Instituto de Salud Carlos III,Madrid,Spain"},{"name":"Liver Unit, Hospital Clinic\u2010IDIBAPS,University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gin\u2010Ho","family":"Lo","sequence":"additional","affiliation":[{"name":"E\u2010DA Hospital,Kaohsiung,Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiv","family":"Sarin","sequence":"additional","affiliation":[{"name":"Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barjesh","family":"Sharma","sequence":"additional","affiliation":[{"name":"Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan G.","family":"Abraldes","sequence":"additional","affiliation":[{"name":"Cirrhosis Care Clinic,Division of Gastroenterology (Liver Unit), University of Alberta, 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