Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices

Annals of Hepatology

Sebastián Valderrama¹  René Sánchez²  Francisco Otarola³  Brenda Medina⁴  Rosa María Pérez-Ayuso, MD.⁵  Manuel Espinoza⁶  Arnoldo Riquelme⁶  Antonio Rollán⁷ 

[1] Correspondence to the author:;Hospital de Urgencias Asistencia Pública;Department of Gastoenterology, Latin-American Endoscopic Training Center, Facultad de Medicina, Universidad del Desarrollo - Clínica Alemana, Santiago, Chile;Department of Gastroenterology and Endoscopy Unit, Hospital Dr. Sótero del Río;Department of Gastroenterology;Department of Internal Medicine;Department of Public Health, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile;

关键词: Primary prophylaxis;    Endoscopic band ligation;    Propranolol;    Beta-Blockers;    Variceal bleeding;    Cirrhosis;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background. Gastroesophageal variceal bleeding is a common complication of portal hypertension. Current guidelines recommend β-blockers for primary prophylaxis. However, evidence suggests that endoscopic variceal ligation (EVL) reduce bleeding episodes.Aims. To compare endoscopic EVL with propranolol (PPL) for primary prophylaxis of variceal bleeding.Methods. We conducted a randomized controlled trial. Over a 9-year period, 75 patients with cirrhosis and high-risk esophageal varices (HREV) were recruited and allocated to EVL (n=39) or PPL (n=36). Primary outcome was variceal bleeding. Secondary outcomes were survival, source of bleeding and serious adverse events. Analyses were made by intention-to-treat.Results. Baseline characteristics were similar. Medium follow-up was 1647±1096 days. Complete follow-up was achieved in 85% of patients. Variceal bleeding occurred in 12% of EVL and in 25% of PPL group (p=0.17). The actuarial risks of bleeding after 2 years were similar in both groups. Overall mortality was 51% in EVL and 33% in PPL group (p=0.17). Patients in the EVL group showed a lower rate of esophageal variceal bleeding (5.1% v/s 25%, p=0.027) and a higher rate of subcardial variceal bleeding compared with PPL group (7.7% v/s 0%, p=0.027). Serious adverse events related to EVL occurred in 2 patients, including 1 death.Conclusions. The present study supports that PPL should be considered the first choice in primary prophylaxis of variceal bleeding offering similar effects and lower severe adverse events compared with EVL.

【 授权许可】

Unknown