[Nadolol as an adjuvant to sclerotherapy of esophageal varices for prevention of recurrent hemorrhaging].
OBJECTIVE
to assess whether nadolol could improve the results of sclerotherapy in the prevention of varices rebleeding.


METHODS
prospective study in which patients with cirrhosis and Child-Pugh's class A or B and with their first hemorrhage from esophageal varices, diagnosed by emergency endoscopy, were included. After initial control of bleeding with emergency sclerotherapy, the patients were randomized into two groups to receive long-term variceal sclerotherapy either alone (group 1) or plus nadolol (group 2). Sclerotherapy was performed by intravariceal injection of 5% ethanolamine at days 0, 4 10, 30 and then monthly until eradication of varices. Nadolol was administered during the whole follow-up in a dose to reduce resting pulse rate by 25% (mean final dose: 82 +/- 31 mg/d).


METHODS
During a two year period (1989-1991), 40 patients with cirrhosis (from alcohol abuse in 48%), were included. 18 patients were allocated in group 1 and 22 in group 2.


RESULTS
Both groups were well-matched for clinical, biological and endoscopic data. Follow-up was similar in both (24.3 +/- 10.6 months in group 1 vs 27.3 +/- 9.8 in group 2). Nine patients in group 1 (50%) and 13 in group 2 (59%) rebled during the follow-up, with a total number of 14 and 22 rebleeding episodes respectively (p = NS). There were no differences between the two groups when considering rebleeding index, transfusional requirements per rebleeding episode and the cumulative percentage of patients free from rebleeding. Severe complications attributable to treatment were observed in 22% of patients in group 1 and in 27% in group 2 (p = NS). Two patients died in each group.


CONCLUSIONS
In patients undergoing long-term sclerotherapy for prevention of variceal rebleeding, nadolol confers no additional benefit.
Villanueva
C
C
Unidad de Sangrantes, Hospital de la Santa Creu i Sant Pau, Barcelona.
Martínez
F J
FJ
Torras
X
X
Sáinz
S
S
Soriano
G
G
González
D
D
Balanzó
J
J
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy
D009248:Nadolol
Nadolol como coadyuvante a la escleroterapia de varices esofágicas en la profilaxis de recidiva hemorrágica.