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Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis
Author(s) -
Schepke Michael,
Kleber Gerhard,
Nürnberg Dieter,
Willert Jörg,
Koch Lydia,
VeltzkeSchlieker Wilfried,
Hellerbrand Claus,
Kuth Johannes,
Schanz Stefan,
Kahl Stefan,
Fleig Wolfgang E.,
Sauerbruch Tilman
Publication year - 2004
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20284
Subject(s) - medicine , ligation , cirrhosis , varices , propranolol , incidence (geometry) , gastroenterology , etiology , randomized controlled trial , surgery , esophageal varices , portal hypertension , physics , optics
In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty‐two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n = 75) or PPL (n = 77). The groups were well matched with respect to baseline characteristics (age 56 ± 10 years, alcoholic etiology 51%, Child‐Pugh score 7.2 ± 1.8). The mean follow‐up was 34 ± 19 months. Data were analyzed on an intention‐to‐treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2‐year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion , VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long‐term PPL treatment. (H EPATOLOGY 2004;40:65–72.)