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Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial.
Hepatology. 2005 Mar; 41(3):572-8.Hep

Abstract

beta-Blockers and endoscopic variceal ligation (EVL) have proven to be valuable methods in the prevention of variceal rebleeding. The aim of this study was to compare the efficacy of EVL combined with nadolol versus EVL alone as secondary prophylaxis for variceal bleeding. Patients admitted for acute variceal bleeding were treated during emergency endoscopy with EVL or sclerotherapy and received somatostatin for 5 days. At that point, patients were randomized to receive EVL plus nadolol or EVL alone. EVL sessions were repeated every 10 to 12 days until the varices were eradicated. Eighty patients with cirrhosis (alcoholic origin in 66%) were included (Child-Turcotte-Pugh A, 15%; B, 56%; C, 29%). The median follow-up period was 16 months (range, 1-24 months). The variceal bleeding recurrence rate was 14% in the EVL plus nadolol group and 38% in the EVL group (P = .006). Mortality was similar in both groups: five patients (11.6%) died in the combined therapy group and four patients (10.8%) died in the EVL group. There were no significant differences in the number of EVL sessions to eradicate varices: 3.2 +/- 1.3 in the combined therapy group versus 3.5 +/- 1.3 in the EVL alone group. The actuarial probability of variceal recurrence at 1 year was lower in the EVL plus nadolol group (54%) than in the EVL group (77%; P = .06). Adverse effects resulting from nadolol were observed in 11% of the patients. In conclusion, nadolol plus EVL reduces the incidence of variceal rebleeding compared with EVL alone. A combined treatment could lower the probability of variceal recurrence after eradication.

Authors+Show Affiliations

de la Peña J
Hospital Universitario Marques de Valdecilla, Santander, Spain. jpena@humv.es
Brullet E
No affiliation info available
Sanchez-Hernández E
No affiliation info available
Rivero M
No affiliation info available
Vergara M
No affiliation info available
Martin-Lorente JL
No affiliation info available
Garcia Suárez C
No affiliation info available

MeSH

Adrenergic beta-AntagonistsAdultAgedEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHumansLigationMaleMiddle AgedNadololProspective StudiesRecurrence

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15726659

Clinical Trial Links

Preventing Recurrent Bleeding After Eradication of Esophageal Varices

Citation

de la Peña, Joaquin, et al. "Variceal Ligation Plus Nadolol Compared With Ligation for Prophylaxis of Variceal Rebleeding: a Multicenter Trial." Hepatology (Baltimore, Md.), vol. 41, no. 3, 2005, pp. 572-8.
de la Peña J, Brullet E, Sanchez-Hernández E, et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology. 2005;41(3):572-8.
de la Peña, J., Brullet, E., Sanchez-Hernández, E., Rivero, M., Vergara, M., Martin-Lorente, J. L., & Garcia Suárez, C. (2005). Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology (Baltimore, Md.), 41(3), 572-8.
de la Peña J, et al. Variceal Ligation Plus Nadolol Compared With Ligation for Prophylaxis of Variceal Rebleeding: a Multicenter Trial. Hepatology. 2005;41(3):572-8. PubMed PMID: 15726659.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. AU - de la Peña,Joaquin, AU - Brullet,Enric, AU - Sanchez-Hernández,Eloy, AU - Rivero,Monserrat, AU - Vergara,Mercedes, AU - Martin-Lorente,Jose Luis, AU - Garcia Suárez,Covadonga, PY - 2005/2/24/pubmed PY - 2005/3/18/medline PY - 2005/2/24/entrez SP - 572 EP - 8 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 41 IS - 3 N2 - beta-Blockers and endoscopic variceal ligation (EVL) have proven to be valuable methods in the prevention of variceal rebleeding. The aim of this study was to compare the efficacy of EVL combined with nadolol versus EVL alone as secondary prophylaxis for variceal bleeding. Patients admitted for acute variceal bleeding were treated during emergency endoscopy with EVL or sclerotherapy and received somatostatin for 5 days. At that point, patients were randomized to receive EVL plus nadolol or EVL alone. EVL sessions were repeated every 10 to 12 days until the varices were eradicated. Eighty patients with cirrhosis (alcoholic origin in 66%) were included (Child-Turcotte-Pugh A, 15%; B, 56%; C, 29%). The median follow-up period was 16 months (range, 1-24 months). The variceal bleeding recurrence rate was 14% in the EVL plus nadolol group and 38% in the EVL group (P = .006). Mortality was similar in both groups: five patients (11.6%) died in the combined therapy group and four patients (10.8%) died in the EVL group. There were no significant differences in the number of EVL sessions to eradicate varices: 3.2 +/- 1.3 in the combined therapy group versus 3.5 +/- 1.3 in the EVL alone group. The actuarial probability of variceal recurrence at 1 year was lower in the EVL plus nadolol group (54%) than in the EVL group (77%; P = .06). Adverse effects resulting from nadolol were observed in 11% of the patients. In conclusion, nadolol plus EVL reduces the incidence of variceal rebleeding compared with EVL alone. A combined treatment could lower the probability of variceal recurrence after eradication. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/15726659/Variceal_ligation_plus_nadolol_compared_with_ligation_for_prophylaxis_of_variceal_rebleeding:_a_multicenter_trial_ DB - PRIME DP - Unbound Medicine ER -