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Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding.
Hepatol Int 2018; 12(1):75-82HI

Abstract

BACKGROUND AND AIMS

Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year.

METHODS

The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol.

RESULTS

Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III.

CONCLUSIONS

Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.

Authors+Show Affiliations

Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt. walfou2000@gmail.com.Tropical Medicine Department, Theodor Bilharz Research Institute, Giza, Egypt.Pharmacology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Pathology Department, Theodor Bilharz Research Institute, Giza, Egypt.Tropical Medicine Department, Theodor Bilharz Research Institute, Giza, Egypt.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29185106

Citation

Abd ElRahim, Ayman Yosry, et al. "Efficacy of Carvedilol Versus Propranolol Versus Variceal Band Ligation for Primary Prevention of Variceal Bleeding." Hepatology International, vol. 12, no. 1, 2018, pp. 75-82.
Abd ElRahim AY, Fouad R, Khairy M, et al. Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding. Hepatol Int. 2018;12(1):75-82.
Abd ElRahim, A. Y., Fouad, R., Khairy, M., Elsharkawy, A., Fathalah, W., Khatamish, H., ... Seyam, M. (2018). Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding. Hepatology International, 12(1), pp. 75-82. doi:10.1007/s12072-017-9835-9.
Abd ElRahim AY, et al. Efficacy of Carvedilol Versus Propranolol Versus Variceal Band Ligation for Primary Prevention of Variceal Bleeding. Hepatol Int. 2018;12(1):75-82. PubMed PMID: 29185106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding. AU - Abd ElRahim,Ayman Yosry, AU - Fouad,Rabab, AU - Khairy,Marwa, AU - Elsharkawy,Aisha, AU - Fathalah,Waleed, AU - Khatamish,Haytham, AU - Khorshid,Omayma, AU - Moussa,Mona, AU - Seyam,Moataz, Y1 - 2017/11/28/ PY - 2016/11/01/received PY - 2017/11/02/accepted PY - 2017/12/1/pubmed PY - 2018/11/6/medline PY - 2017/11/30/entrez KW - Band ligation KW - Carvedilol KW - Portal hypertension KW - Primary prophylaxis KW - Propranolol KW - Varices SP - 75 EP - 82 JF - Hepatology international JO - Hepatol Int VL - 12 IS - 1 N2 - BACKGROUND AND AIMS: Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year. METHODS: The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol. RESULTS: Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III. CONCLUSIONS: Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/29185106/Efficacy_of_carvedilol_versus_propranolol_versus_variceal_band_ligation_for_primary_prevention_of_variceal_bleeding_ L2 - https://dx.doi.org/10.1007/s12072-017-9835-9 DB - PRIME DP - Unbound Medicine ER -