STOP PPIS - NO REDUCTION IN BLEEDING OR MORTALITY AFTER ENDOSCOPIC BANDING LIGATION FOR ESOPHAGEAL VARICES IN CIRRHOTICS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Introduction and Objectives

Proton pump inhibitors (PPIs) are frequently prescribed to reduce bleeding and mortality after endoscopic band ligation (EBL) of esophageal varices in cirrhotic patients. However, the clinical benefit remains uncertain. This meta-analysis aims to determine whether PPI therapy reduces bleeding and mortality within 8 weeks following EBL of esophageal varices in cirrhotic patients, compared to non-use.

Materials and Methods

The search was conducted in PubMed, Web of Science and CENTRAL in January 2025. Randomized controlled trials (RCTs) comparing PPI use after EBL in cirrhotic patients versus non-use were included. The primary outcome was bleeding, and,the secondary, was mortality, both within 8 weeks. Two independently students extracted data and assessed risk of bias, using the Cochrane Risk of Bias tool (RoB 2). Relative risks (RRs) with 95% CI were calculated by random-effects model.

Results

Four RCTs including 445 cirrhotic patients who underwent EBL were included. All studies contributed to the primary outcome and three of them, including 268 patients, to the secondary outcome. In pooled analysis, PPI use was not associated with a reduced risk of bleeding within 8 weeks (RR 0.71; 95% CI: 0.39 - 1.30; I² = 0.0%), or mortality (RR 0.75; 95% CI: 0.23 - 2.53; I² = 0.0%).

Conclusions

This meta-analysis indicates that PPI therapy after EBL for esophageal varices in cirrhotic patients has no evidence of reducing risk of bleeding or death compared to non-use and discourages the indiscriminate use of PPIs when no proven benefit exists.