{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:14:46Z","timestamp":1784888086889,"version":"3.55.0"},"reference-count":43,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,1,24]],"date-time":"2014-01-24T00:00:00Z","timestamp":1390521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Fondo de Investigaciones Sanitarias","award":["PI10\/01552"],"award-info":[{"award-number":["PI10\/01552"]}]},{"DOI":"10.13039\/100011995","name":"Fundaci\u00f3 Investigaci\u00f3 Sant Pau","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011995","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2014,7]]},"abstract":"Abstract<\/jats:title>\n \n Background & Aims<\/jats:title>\n \n Combined therapy with endoscopic variceal ligation (\n EVL<\/jats:styled-content>\n ) and \u03b2\u2010blockers\u00a0\u00b1\u00a0isosorbide mononitrate (\n ISMN<\/jats:styled-content>\n ) is currently recommended to prevent variceal rebleeding. However, the role of this combined therapy has been challenged by some studies. We performed a systematic review to assess the value of combined therapy with\n EVL<\/jats:styled-content>\n and \u03b2\u2010blockers\u00a0\u00b1\u00a0\n ISMN<\/jats:styled-content>\n as compared with each treatment alone to prevent rebleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Databases, references and meeting abstracts were searched to retrieve randomized trials comparing combined therapy with\n EVL<\/jats:styled-content>\n and \u03b2\u2010blockers\u00a0\u00b1\u00a0\n ISMN<\/jats:styled-content>\n vs either treatment alone, to prevent variceal rebleeding in cirrhosis. Random\u2010effects model was used for meta\u2010analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We identified five studies comparing\n EVL<\/jats:styled-content>\n alone or combined with drugs, including a total of 476 patients. Combination therapy reduced overall rebleeding [risk ratios (RR)\u00a0=\u00a00.44, 95% confidence interval (CI)\u00a0=\u00a00.28\u20130.69], and showed a trend towards lower mortality (RR\u00a0=\u00a00.58, 95% CI\u00a0=\u00a00.33\u20131.03), without increasing complications. We identified four trials comparing drugs alone or associated with\n EVL<\/jats:styled-content>\n , including 409 patients. All used \u03b2\u2010blockers plus\n ISMN<\/jats:styled-content>\n . Variceal rebleeding decreased with combined therapy (\n P<\/jats:italic>\n \u00a0<\u00a00.01) but rebleeding from oesophageal ulcers increased (\n P<\/jats:italic>\n \u00a0=\u00a00.01). Overall, there was a trend towards lower rebleeding (RR\u00a0=\u00a00.76, 95% CI\u00a0=\u00a00.58\u20131.00) without effect on mortality (RR\u00a0=\u00a01.24, 95% CI\u00a0=\u00a00.90\u20131.70).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The addition of drug therapy to\n EVL<\/jats:styled-content>\n improves the efficacy of\n EVL<\/jats:styled-content>\n alone. However, the addition of\n EVL<\/jats:styled-content>\n to \u03b2\u2010blockers and\n ISMN<\/jats:styled-content>\n achieves a non\u2010significant decrease of rebleeding with no effect on mortality. Although combination therapy with\n EVL<\/jats:styled-content>\n plus \u03b2\u2010blockers\u00a0\u00b1\u00a0\n ISMN<\/jats:styled-content>\n is adequate to prevent rebleeding, \u03b2\u2010blockers\u00a0+\u00a0\n ISMN<\/jats:styled-content>\n alone may be a valid alternative.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/liv.12452","type":"journal-article","created":{"date-parts":[[2013,12,24]],"date-time":"2013-12-24T03:40:49Z","timestamp":1387856449000},"page":"823-833","source":"Crossref","is-referenced-by-count":116,"title":["Drugs plus ligation to prevent rebleeding in cirrhosis: an updated systematic review"],"prefix":"10.1111","volume":"34","author":[{"given":"Angela","family":"Puente","sequence":"first","affiliation":[{"name":"Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Autonomous University Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Hern\u00e1ndez\u2010Gea","sequence":"additional","affiliation":[{"name":"Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Autonomous University Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Graupera","sequence":"additional","affiliation":[{"name":"Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Autonomous University Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Roque","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Iberioamerican Cochrane Center Hospital de la Santa Creu i Sant Pau Autonomous University Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Colomo","sequence":"additional","affiliation":[{"name":"Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Autonomous University Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Poca","sequence":"additional","affiliation":[{"name":"Gastrointestinal Bleeding Unit Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Autonomous University Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carles","family":"Aracil","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hospital Arnau de Vilanova Lleida 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Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd) Barcelona 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