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Equal Efficacy of Endoscopic Variceal Ligation and Propranolol in Preventing Variceal Bleeding in Patients with Non-Cirrhotic Portal Hypertension.
Gastroenterology. 2010 Jun 11;
Authors: Sarin SK, Gupta N, Jha SK, Aggarwal A, Mishra SR, Sharma BC, Kumar A
BACKGROUND:: Variceal bleeding increases morbidity and mortality among patients with non-cirrhotic portal hypertension (NCPH). Blockers of beta-adrenergic receptor signaling and endoscopic variceal ligation (EVL) have been used to prevent recurrence of bleeding, based on data from cirrhotic patients. We compared the efficacy and safety of the beta-blocker propranolol with that of EVL in preventing the recurrence of variceal bleeding in patients with NCPH. METHODS:: Consecutive patients of NCPH with history of variceal bleeding in the past 6 weeks were randomly assigned to groups treated every 3 weeks with EVL (n=51) or propranolol (until they had a resting heart rate of 55 bpm or to a maximum of 320 mg/d; n=50). Primary endpoints were recurrence of variceal bleeding or death. Secondary endpoints were complications of EVL in patients given propranolol, variceal eradication following EVL, variceal recurrence after EVL, or a decrease in variceal grade in patients given propranolol. RESULTS:: After a median follow-up period of 23 months, rates of recurrence of bleeding were similar between the groups (EVL=23.5%, propranolol=18%; P=0.625). The actuarial probability of remaining free bleeding recurrence was similar between the groups. No deaths occurred in either group. Of the patients given propranolol, 47% had a decrease in the grade of varices and none experienced bleeding. Adverse events were minor and comparable between groups (EVL=12%, propranolol=18%; P=0.635). CONCLUSIONS:: EVL was not more effective than the beta-blocker propranolol for the secondary prophylaxis of variceal bleeding in patients with NCPH.
PMID: 20547163 [PubMed - as supplied by publisher]