title: Endoscopic variceal ligation vs. propranolol for prevention of first variceal bleeding: a randomized controlled trial.
abstract: OBJECTIVE
  Data in the literature regarding the role of endoscopic variceal ligation for the prevention of first variceal bleeding in cirrhotic patients are controversial. To further explore this issue we have compared ligation and propranolol treatment in a prospective randomized study.
  
  
  METHODS
  Sixty patients with cirrhosis and oesophageal varices with no history but at high risk of bleeding were randomized to ligation treatment (30 patients) or propranolol (30 patients). Patients were followed for approximately 27.5 months.
  
  
  RESULTS
  Variceal obliteration was achieved in 28 patients (93.3%) after 3+/-1 sessions. The mean daily dose of propranolol was 60.3+/-13.3 mg. Two patients (6.7%) in the ligation group and nine patients (30%) in the propranolol group developed variceal bleeding (P = 0.043). The actuarial risks of variceal bleeding at 2 years were 6.7% and 25%, respectively. On multivariate analysis, propranolol treatment and grade III varices turned out to be predictive factors for the risk of variceal bleeding. Mortality was not different between the two groups. There were no serious complications due to ligation. Propranolol treatment was discontinued in four patients because of side effects.
  
  
  CONCLUSIONS
  Variceal ligation is a safe and more effective method than propranolol treatment for the prevention of first variceal bleeding in cirrhotic patients with high-risk varices.
authors.affiliation: Academic Department of Gastroenterology, Helena Venizelou General Hospital, Faculty of Nursing, Athens University, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Psilopoulos
authors.forename: Petros
authors.initials: P
authors.lastname: Galanis
authors.forename: Spyros
authors.initials: S
authors.lastname: Goulas
authors.forename: Ioannis S
authors.initials: IS
authors.lastname: Papanikolaou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Elefsiniotis
authors.forename: Christos
authors.initials: C
authors.lastname: Liatsos
authors.forename: Loukas
authors.initials: L
authors.lastname: Sparos
authors.forename: Christos
authors.initials: C
authors.lastname: Mavrogiannis
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002423:Cause of Death; D004812:Epidemiologic Methods; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol