Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis.
In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n = 75) or PPL (n = 77). The groups were well matched with respect to baseline characteristics (age 56 +/- 10 years, alcoholic etiology 51%, Child-Pugh score 7.2 +/- 1.8). The mean follow-up was 34 +/- 19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment.
Schepke
Michael
M
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Kleber
Gerhard
G
Nürnberg
Dieter
D
Willert
Jörg
J
Koch
Lydia
L
Veltzke-Schlieker
Wilfried
W
Hellerbrand
Claus
C
Kuth
Johannes
J
Schanz
Stefan
S
Kahl
Stefan
S
Fleig
Wolfgang E
WE
Sauerbruch
Tilman
T
D000206:Actuarial Analysis; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol