Propranolol alone may not be acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients: randomized controlled trial.
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.
Tomikawa
Morimasa
M
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
Shimabukuro
Rinshun
R
Okita
Keishi
K
Tsutsumi
Norifumi
N
Akahoshi
Tomohiko
T
Hashizume
Makoto
M
Sugimachi
Keizo
K
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
D000319:Adrenergic beta-Antagonists; D011433:Propranolol