Sharma M, et al. - A systematic review with network meta-analysis (NMA) was performed to compare the effectiveness of different approaches in the primary prevention of esophageal variceal bleeding and overall survival in cirrhotic patients with large varices via including 32 randomized clinical trials (RCT) with 3362 cirrhotic adults with large esophageal varices and no prior history of bleeding, with minimum 12m follow-up. In cirrhotic patients with large esophageal varices, nonselective beta- blockers (NSBB) monotherapy might decrease all-cause mortality and the risk of first variceal bleeding. Compared to variceal band ligation (VBL), NSBB carries a lower risk of serious complications. For primary prophylaxis of esophageal variceal bleeding, NSBB might be the preferred initial approach.