The coming of age of band ligation for oesophageal varices

摘要

In this age of evidence based medicine one question that remains hard to answer is at what stage the results of clinical trials should lead to changes in clinical practice. Even when reassured by the size of the sample and quality of the population, clinicians seem to remain doubtful about whether clinical practice should be changed on the basis of one or two studies. Not uncommonly, for example, the results from an apparently well conducted study are not borne out or initially conflicting results eventually become clearer as more data accumulate. This was the case with the original observation by Lebrec et al that propranolol could reduce rebleeding from oesophageal varices, which was followed rapidly by another study that showed no benefit whatsoever. Nearly all subsequent studies have confirmed the original observations, but people became persuaded only when a meta-analysis had been undertaken. The situation with band ligation for oesophageal varices is different: all the studies so far have shown an advantage over the standard treatment, but it is not yet widely used in clinical practice.