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Endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleed: Preliminary report of a randomized controlled trial
Author(s) -
De Binay,
Ghoshal Udaym,
Das Tapas,
Santra Amal,
Biswas Pranab
Publication year - 1999
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1046/j.1440-1746.1999.01800.x
Subject(s) - medicine , portal hypertension , varices , portal venous pressure , sclerotherapy , bleed , surgery , gastroenterology , propranolol , randomized controlled trial , gastrointestinal bleeding , terlipressin , complication , varix , cirrhosis , hepatorenal syndrome
Background : Prevention of variceal bleeding, a major cause of morbidity and mortality, is an important goal in the management of patients with portal hypertension (PHT). Although propranolol has been found useful in preventing the first episode of variceal bleeding (primary prophylaxis) in cirrhotic PHT, it has limitations which include side effects, contraindications, non‐compliance and failure in some patients. Endoscopic variceal ligation (EVL) has not been used for primary prophylaxis. Methods: Thirty cirrhotic patients with PHT, grade III to IV oesophageal varices, hepatic venous pressure gradient ≥ 12 mmHg and no prior history of upper gastrointestinal bleeding were randomized to receive propranolol (to reduce their pulse rate by 25% from baseline, n = 15) and EVL (weekly to fortnightly until variceal eradication, n = 15). The two groups were comparable. All the patients in EVL group had variceal eradication during 3.8 ± 2.2 sessions. Results: There was no major complication or interval bleeding. During a follow‐up period of 17.6 ± 4.7 months, varices recurred in three, two of which bled (successfully treated by EVL). In contrast, during this period of follow up one patient in the propranolol group had variceal bleeding (P = NS). Side effects of propranolol included symptomatic bradycardia requiring reduction of dose in one of 15 patients. Conclusions : Although sample size in this study is small, it seems that EVL may be a good option for primary prophylaxis for variceal bleeding in patients with cirrhotic PHT; further studies on a larger number of patients and longer follow up are required.