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Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension.
Gastroenterology 2010; 139(4):1238-45G

Abstract

BACKGROUND & AIMS

Variceal bleeding increases morbidity and mortality among patients with noncirrhotic portal hypertension (NCPH). Blockers of β-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 β-blocker propranolol with that of EVL in preventing the recurrence of variceal bleeding in patients with NCPH.

METHODS

Consecutive patients with NCPH with a history of variceal bleeding in the past 6 weeks were assigned randomly to groups treated every 3 weeks with EVL (n = 51) or propranolol (until they had a resting heart rate of 55 beats per minute or to a maximum of 320 mg/day; n = 50). Primary end points were recurrence of variceal bleeding or death. Secondary end points were complications of EVL in patients given EVL, variceal eradication after 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 = .625). The actuarial probability of remaining free of 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 = .635).

CONCLUSIONS

EVL was not more effective than the β-blocker propranolol for the secondary prophylaxis of variceal bleeding in patients with NCPH.

Authors+Show Affiliations

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India. shivsarin@gmail.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

20547163

Citation

Sarin, Shiv Kumar, et al. "Equal Efficacy of Endoscopic Variceal Ligation and Propranolol in Preventing Variceal Bleeding in Patients With Noncirrhotic Portal Hypertension." Gastroenterology, vol. 139, no. 4, 2010, pp. 1238-45.
Sarin SK, Gupta N, Jha SK, et al. Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension. Gastroenterology. 2010;139(4):1238-45.
Sarin, S. K., Gupta, N., Jha, S. K., Agrawal, A., Mishra, S. R., Sharma, B. C., & Kumar, A. (2010). Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension. Gastroenterology, 139(4), pp. 1238-45. doi:10.1053/j.gastro.2010.06.017.
Sarin SK, et al. Equal Efficacy of Endoscopic Variceal Ligation and Propranolol in Preventing Variceal Bleeding in Patients With Noncirrhotic Portal Hypertension. Gastroenterology. 2010;139(4):1238-45. PubMed PMID: 20547163.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension. AU - Sarin,Shiv Kumar, AU - Gupta,Nitin, AU - Jha,Sanjeev Kumar, AU - Agrawal,Amit, AU - Mishra,Smruti Ranjan, AU - Sharma,Barjesh Chander, AU - Kumar,Ashish, Y1 - 2010/06/12/ PY - 2010/01/04/received PY - 2010/05/21/revised PY - 2010/06/08/accepted PY - 2010/6/16/entrez PY - 2010/6/16/pubmed PY - 2010/10/23/medline SP - 1238 EP - 45 JF - Gastroenterology JO - Gastroenterology VL - 139 IS - 4 N2 - BACKGROUND & AIMS: Variceal bleeding increases morbidity and mortality among patients with noncirrhotic portal hypertension (NCPH). Blockers of β-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 β-blocker propranolol with that of EVL in preventing the recurrence of variceal bleeding in patients with NCPH. METHODS: Consecutive patients with NCPH with a history of variceal bleeding in the past 6 weeks were assigned randomly to groups treated every 3 weeks with EVL (n = 51) or propranolol (until they had a resting heart rate of 55 beats per minute or to a maximum of 320 mg/day; n = 50). Primary end points were recurrence of variceal bleeding or death. Secondary end points were complications of EVL in patients given EVL, variceal eradication after 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 = .625). The actuarial probability of remaining free of 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 = .635). CONCLUSIONS: EVL was not more effective than the β-blocker propranolol for the secondary prophylaxis of variceal bleeding in patients with NCPH. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/20547163/Equal_efficacy_of_endoscopic_variceal_ligation_and_propranolol_in_preventing_variceal_bleeding_in_patients_with_noncirrhotic_portal_hypertension_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(10)00876-0 DB - PRIME DP - Unbound Medicine ER -