title: Propranolol alone may not be acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients: randomized controlled trial.
abstract: OBJECTIVE
  In Japan, endoscopic injection sclerotherapy (EIS) is widely used to prevent first esophageal variceal bleeding, in contrast to pharmacological therapy which is the main treatment used in the rest of the world. The present study investigated if propranolol alone is acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients. This was compared with EIS.
  
  
  METHODS
  Twenty-five Japanese cirrhotic patients with endoscopically proven, likely to bleed esophageal varices were randomly assigned for propranolol administration (12 patients; group A) and EIS (13 patients; group B) to prevent first esophageal variceal bleeding. Complications, non-recurrence rate, bleeding rate and probability of survival were compared between the two groups.
  
  
  RESULTS
  One patient in group A had severe bradycardia with loss of consciousness that seriously worsened his quality of life. The cumulative non-recurrence rate of group A was significantly lower compared with that of group B (P < 0.05). In group A, 2 of the 12 patients requested to discontinue taking propranolol and were excluded from the trial. The EIS treatment (group B) showed excellent results. No patient in group A or group B bled from esophageal varices throughout this study. The two groups showed no statistically significant differences in probability of survival.
  
  
  CONCLUSIONS
  Propranolol alone may not be acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients.
authors.affiliation: Department of Surgery and Science. Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. mtomikaw@surg2.med.kyushu-u.ac.jp
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Rinshun
authors.initials: R
authors.lastname: Shimabukuro
authors.forename: Keishi
authors.initials: K
authors.lastname: Okita
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Keizo
authors.initials: K
authors.lastname: Sugimachi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007564:Japan; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D015911:Sclerotherapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol