title: Primary prophylaxis of variceal bleeding in cirrhotics awaiting liver transplantation.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of prophylactic band ligation and propranolol versus propranolol alone for the primary prophylaxis of variceal bleeding in patients with high-risk esophageal varices listed for liver transplantation.
  
  
  METHODS
  Out of 152 cirrhotic patients included on the waiting list between January 2001 and January 2003, high-risk esophageal varices were detected in 72. These patients were randomized to undergo combined therapy or propranolol monotherapy. The actuarial probabilities of bleeding from esophageal varices and bleeding-related death were calculated by Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  Variceal eradication was achieved in 33 patients (91.6%) in 2.5 +/- 1.4 ligation sessions. The mean daily dose of propranolol was 72 +/- 25mg in the propranolol group and 68 +/- 21 mg in the ligation group. Six percent of patients in the ligation group and 31% in the propranolol group had one episode of bleeding during the 18 months of follow-up (p = 0.03). The actuarial probabilities of bleeding-free survival after 18 months of follow-up, in the ligation and monotherapy groups were 96% and, respectively, 69% (p = 0.04).
  
  
  CONCLUSIONS
  Endoscopic band ligation associated with propranolol significantly reduces the occurrence of the first episode of variceal bleeding and improves bleeding-related survival in cirrhotics included on the waiting list.
authors.affiliation: Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. drgheorghe@xnet.ro
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Liana
authors.initials: L
authors.lastname: Gheorghe
authors.forename: Speranta
authors.initials: S
authors.lastname: Iacob
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol