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Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding.
N Engl J Med. 1999 Apr 01; 340(13):988-93.NEJM

Abstract

BACKGROUND AND METHODS

We compared propranolol therapy and endoscopic ligation for the primary prevention of bleeding from esophageal varices. This prospective, controlled trial included consecutive eligible patients who had large varices (>5 mm in diameter) that were at high risk for bleeding. The patients were assigned to either propranolol therapy, at a dose sufficient to decrease the base-line heart rate by 25 percent, or variceal ligation, to be performed weekly until the varices were obliterated or so reduced in size that it was not possible to continue treatment.

RESULTS

Of the 89 patients, 82 of whom had cirrhosis of the liver, 44 received propranolol and 45 underwent variceal ligation. The mean (+/-SD) duration of follow-up in each group was 14+/-9 and 13+/-10 months, respectively. The mean time required to achieve an adequate reduction in the heart rate was 2.5+/-1.7 days; the mean number of sessions needed to complete variceal ligation was 3.2+/-1.1. After 18 months, the actuarial probability of bleeding was 43 percent in the propranolol group and 15 percent in the ligation group (P=0.04). Twelve patients in the propranolol group and four in the ligation group had bleeding. Three of the four in the ligation group had bleeding before their varices had been obliterated. Nine patients in the ligation group had recurrent varices, a mean of 3.7 months after the initial treatment. Five patients in each group died; bleeding from the varices was the cause of death of four patients in the propranolol group and of three in the ligation group. There were no serious complications of variceal ligation; in the propranolol group, treatment was stopped in two patients because of side effects.

CONCLUSIONS

In patients with high-risk esophageal varices, endoscopic ligation of the varices is safe and more effective than propranolol for the primary prevention of variceal bleeding.

Authors+Show Affiliations

Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India. sksarin@nda.vsnl.net.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10099140

Citation

Sarin, S K., et al. "Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding." The New England Journal of Medicine, vol. 340, no. 13, 1999, pp. 988-93.
Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med. 1999;340(13):988-93.
Sarin, S. K., Lamba, G. S., Kumar, M., Misra, A., & Murthy, N. S. (1999). Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. The New England Journal of Medicine, 340(13), 988-93.
Sarin SK, et al. Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding. N Engl J Med. 1999 Apr 1;340(13):988-93. PubMed PMID: 10099140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. AU - Sarin,S K, AU - Lamba,G S, AU - Kumar,M, AU - Misra,A, AU - Murthy,N S, PY - 1999/4/1/pubmed PY - 2000/3/11/medline PY - 1999/4/1/entrez SP - 988 EP - 93 JF - The New England journal of medicine JO - N Engl J Med VL - 340 IS - 13 N2 - BACKGROUND AND METHODS: We compared propranolol therapy and endoscopic ligation for the primary prevention of bleeding from esophageal varices. This prospective, controlled trial included consecutive eligible patients who had large varices (>5 mm in diameter) that were at high risk for bleeding. The patients were assigned to either propranolol therapy, at a dose sufficient to decrease the base-line heart rate by 25 percent, or variceal ligation, to be performed weekly until the varices were obliterated or so reduced in size that it was not possible to continue treatment. RESULTS: Of the 89 patients, 82 of whom had cirrhosis of the liver, 44 received propranolol and 45 underwent variceal ligation. The mean (+/-SD) duration of follow-up in each group was 14+/-9 and 13+/-10 months, respectively. The mean time required to achieve an adequate reduction in the heart rate was 2.5+/-1.7 days; the mean number of sessions needed to complete variceal ligation was 3.2+/-1.1. After 18 months, the actuarial probability of bleeding was 43 percent in the propranolol group and 15 percent in the ligation group (P=0.04). Twelve patients in the propranolol group and four in the ligation group had bleeding. Three of the four in the ligation group had bleeding before their varices had been obliterated. Nine patients in the ligation group had recurrent varices, a mean of 3.7 months after the initial treatment. Five patients in each group died; bleeding from the varices was the cause of death of four patients in the propranolol group and of three in the ligation group. There were no serious complications of variceal ligation; in the propranolol group, treatment was stopped in two patients because of side effects. CONCLUSIONS: In patients with high-risk esophageal varices, endoscopic ligation of the varices is safe and more effective than propranolol for the primary prevention of variceal bleeding. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/10099140/Comparison_of_endoscopic_ligation_and_propranolol_for_the_primary_prevention_of_variceal_bleeding_ L2 - https://www.nejm.org/doi/10.1056/NEJM199904013401302?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -