Banding ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding.
OBJECTIVE
beta-blockers and banding ligation are effective in the prevention of variceal rebleeding. However, the relative efficacy and safety remains unresolved.


METHODS
One hundred twenty-one patients with a history of esophageal variceal bleeding were enrolled. Patients were randomized to undergo regular endoscopic variceal ligation (EVL group, 60 patients) until variceal obliteration, or drug therapy by using nadolol plus isosorbide mononitrate (N+I group, 61 patients) during the study period to prevent rebleeding.


RESULTS
After a median follow-up period of 25 months, recurrent upper gastrointestinal bleeding developed in 23 patients in the EVL group and 35 patients in the N+I group (P = 0.10). Recurrent bleeding from esophageal varices occurred in 12 patients (20%) in the EVL group and 26 patients (42%) in the N+I group (relative risk = 0.45; 95% confidence interval, 0.24-0.85). The actuarial probability of rebleeding from esophageal varices was lower in the EVL group (P = 0.01). The multivariate Cox analysis indicated that the treatment was the only factor predictive of rebleeding. Treatment failure occurred in 8 patients (13%) in the EVL group and 17 patients (28%) in the N+I group (P = 0.01). Fifteen patients in the EVL group and 8 patients of the N+I group died (P = 0.06). Complications occurred in 17% of the EVL group and in 19% of the N+I group (P = 0.6).


CONCLUSIONS
Our trial showed that ligation was more effective than nadolol plus isosorbide-5-mononitrate in the prevention of variceal rebleeding, with similar complications in both treatment modalities. However, there is no significant difference in the survival rate between the 2 groups.
Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China. ghlo@isca.vghks.gov.tw
Gin-Ho
GH
Lo
Wen-Chi
WC
Chen
Mei-Hsiu
MH
Chen
Ping-I
PI
Hsu
Chiun-Ku
CK
Lin
Wei-Lun
WL
Tsai
Kwok-Hung
KH
Lai
D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D008026:Ligation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000009:adverse effects / Q000627:therapeutic use*; D055502:Secondary Prevention; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate