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Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: A multicenter trial
Author(s) -
de la Peña Joaquin,
Brullet Enric,
SanchezHernández Eloy,
Rivero Monserrat,
Vergara Mercedes,
MartinLorente Jose Luis,
Garcia Suárez Covadonga
Publication year - 2005
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.20584
Subject(s) - nadolol , ligation , medicine , cardiology , propranolol
Abstract β‐Blockers and endoscopic variceal ligation (EVL) have proven to be valuable methods in the prevention of variceal rebleeding. The aim of this study was to compare the efficacy of EVL combined with nadolol versus EVL alone as secondary prophylaxis for variceal bleeding. Patients admitted for acute variceal bleeding were treated during emergency endoscopy with EVL or sclerotherapy and received somatostatin for 5 days. At that point, patients were randomized to receive EVL plus nadolol or EVL alone. EVL sessions were repeated every 10 to 12 days until the varices were eradicated. Eighty patients with cirrhosis (alcoholic origin in 66%) were included (Child‐Turcotte‐Pugh A, 15%; B, 56%; C, 29%). The median follow‐up period was 16 months (range, 1–24 months). The variceal bleeding recurrence rate was 14% in the EVL plus nadolol group and 38% in the EVL group ( P = .006). Mortality was similar in both groups: five patients (11.6%) died in the combined therapy group and four patients (10.8%) died in the EVL group. There were no significant differences in the number of EVL sessions to eradicate varices: 3.2 ± 1.3 in the combined therapy group versus 3.5 ± 1.3 in the EVL alone group. The actuarial probability of variceal recurrence at 1 year was lower in the EVL plus nadolol group (54%) than in the EVL group (77%; P = .06). Adverse effects resulting from nadolol were observed in 11% of the patients. In conclusion , nadolol plus EVL reduces the incidence of variceal rebleeding compared with EVL alone. A combined treatment could lower the probability of variceal recurrence after eradication. (H EPATOLOGY 2005;41:572–578.)