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Banding ligation or beta-blockers for primary prevention of variceal bleeding?

Variceal bleeding is one of the most serious complications of liver cirrhosis. Nonselective beta-blockers and endoscopic ligation are considered effective strategies for primary prevention of variceal bleeding, but there is no consensus about which alternative constitutes the best option. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified seven systematic reviews including 21 randomized controlled trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded variceal ligation probably decreases the risk of variceal bleeding and it is associated to less adverse effects when compared with nonselective beta blockers, although probably there is no difference in terms of mortality.