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Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis.
J Gastroenterol Hepatol 2006; 21(2):413-9JG

Abstract

BACKGROUND AND AIM

To compare the efficacy and safety of endoscopic variceal ligation (EVL) with propranolol in prophylaxis on the rate of first esophageal variceal bleeding in patients with cirrhosis.

METHODS

A prospective, randomized trial was conducted in 100 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death.

RESULTS

Life-table curves showed that prophylactic EVL and propranolol were similarly effective for primary prophylaxis of variceal bleeding (11/50 [22%]vs 12/50 [24%]; P = 0.68) and overall mortality (14/50 [28%]vs 12/50 [24%]; P = 0.49). The 2-year cumulative bleeding rate was 18% (9/50) in the EVL group and 16% (8/50) in the propranolol group. The 2-year cumulative mortality rate was 28% (14/50) in the EVL group and 24% (12/50) in the propranolol group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed no significant difference in mortality in both groups (P = 0.86). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. In the propranolol group, the mean daily dosage of the drug was 68.2 +/- 32.8 mg, which was sufficient to reduce the pulse rate by 25%. 20% of patients withdrew from propranolol treatment due to adverse events.

CONCLUSIONS

Prophylaxis EVL is as effective and as safe as treatment with propranolol in decreasing the incidence of first variceal bleeding and death in cirrhotic patients with high-risk esophageal varices.

Authors+Show Affiliations

Division of Hepatology and Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. laycs000@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16509867

Citation

Lay, Chii-Shyan, et al. "Endoscopic Variceal Ligation Versus Propranolol in Prophylaxis of First Variceal Bleeding in Patients With Cirrhosis." Journal of Gastroenterology and Hepatology, vol. 21, no. 2, 2006, pp. 413-9.
Lay CS, Tsai YT, Lee FY, et al. Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis. J Gastroenterol Hepatol. 2006;21(2):413-9.
Lay, C. S., Tsai, Y. T., Lee, F. Y., Lai, Y. L., Yu, C. J., Chen, C. B., & Peng, C. Y. (2006). Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis. Journal of Gastroenterology and Hepatology, 21(2), pp. 413-9.
Lay CS, et al. Endoscopic Variceal Ligation Versus Propranolol in Prophylaxis of First Variceal Bleeding in Patients With Cirrhosis. J Gastroenterol Hepatol. 2006;21(2):413-9. PubMed PMID: 16509867.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis. AU - Lay,Chii-Shyan, AU - Tsai,Yang-Te, AU - Lee,Fa-Yauh, AU - Lai,Yi-Liang, AU - Yu,Cheng-Ju, AU - Chen,Chih-Bin, AU - Peng,Cheng-Yuan, PY - 2006/3/3/pubmed PY - 2006/8/2/medline PY - 2006/3/3/entrez SP - 413 EP - 9 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 21 IS - 2 N2 - BACKGROUND AND AIM: To compare the efficacy and safety of endoscopic variceal ligation (EVL) with propranolol in prophylaxis on the rate of first esophageal variceal bleeding in patients with cirrhosis. METHODS: A prospective, randomized trial was conducted in 100 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. RESULTS: Life-table curves showed that prophylactic EVL and propranolol were similarly effective for primary prophylaxis of variceal bleeding (11/50 [22%]vs 12/50 [24%]; P = 0.68) and overall mortality (14/50 [28%]vs 12/50 [24%]; P = 0.49). The 2-year cumulative bleeding rate was 18% (9/50) in the EVL group and 16% (8/50) in the propranolol group. The 2-year cumulative mortality rate was 28% (14/50) in the EVL group and 24% (12/50) in the propranolol group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed no significant difference in mortality in both groups (P = 0.86). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. In the propranolol group, the mean daily dosage of the drug was 68.2 +/- 32.8 mg, which was sufficient to reduce the pulse rate by 25%. 20% of patients withdrew from propranolol treatment due to adverse events. CONCLUSIONS: Prophylaxis EVL is as effective and as safe as treatment with propranolol in decreasing the incidence of first variceal bleeding and death in cirrhotic patients with high-risk esophageal varices. SN - 0815-9319 UR - https://www.unboundmedicine.com/medline/citation/16509867/Endoscopic_variceal_ligation_versus_propranolol_in_prophylaxis_of_first_variceal_bleeding_in_patients_with_cirrhosis_ L2 - https://doi.org/10.1111/j.1440-1746.2005.04071.x DB - PRIME DP - Unbound Medicine ER -