Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices
Date
2010
Type:
Article
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Abstract
Background. Gastroesophageal variceal bleeding is a common complication of portal hypertension. Currentguidelines recommend β-blockers for primary prophylaxis. However, evidence suggests that endoscopic va-riceal ligation (EVL) reduce bleeding episodes. Aims. To compare endoscopic EVL with propranolol (PPL)for primary prophylaxis of variceal bleeding. Methods. We conducted a randomized controlled trial. Over a9-year period, 75 patients with cirrhosis and high-risk esophageal varices (HREV) were recruited and alloca-ted to EVL (n=39) or PPL (n=36). Primary outcome was variceal bleeding. Secondary outcomes were survi-val, source of bleeding and serious adverse events. Analyses were made by intention-to-treat. Results.Baseline characteristics were similar. Medium follow-up was 1647±1096 days. Complete follow-up wasachieved in 85% of patients. Variceal bleeding occurred in 12% of EVL and in 25% of PPL group (p=0.17).The actuarial risks of bleeding after 2 years were similar in both groups. Overall mortality was 51% in EVLand 33% in PPL group (p=0.17). Patients in the EVL group showed a lower rate of esophageal variceal blee-ding (5.1% v/s 25%, p=0.027) and a higher rate of subcardial variceal bleeding compared with PPL group(7.7% v/s 0%, p=0.027). Serious adverse events related to EVL occurred in 2 patients, including 1 death.Conclusions. The present study supports that PPL should be considered the first choice in primary pro-phylaxis of variceal bleeding offering similar effects and lower severe adverse events compared with EVL
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Citation
Annals of Hepatology January-March, Vol. 9 No.1, 2010: 15-22
Keywords
Primary prophylaxis, Endoscopic band ligation, Propranolol, Beta-Blockers, Variceal bleeding, Cirrhosis