A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation.
Whether beta-blockers (BB) or banding is the best therapy for primary prophylaxis of variceal bleeding is subject to debate. A randomized comparison between the 2 treatments was performed in candidates for liver transplantation (LT). A total of 62 patients with Child-Turcotte-Pugh B-C cirrhosis and high risk varices received propranolol (31) or variceal banding (31). The primary endpoint was variceal bleeding. There were 2 variceal hemorrhages (6.5%) in the banding group, related to postbanding ulcers, and 3 (9.7%) in the propranolol group (P = not significant [n.s.]). Deaths and bleeding related deaths were 3 and 1 for banding and 3 and 2 for BB, respectively (P = n.s.). A total of 14 patients underwent LT in the banding group and 10 in the propranolol group (P = n.s.). Adverse events were 2 postbanding ulcer bleedings in ligated patients (1 fatal) and 5 were intolerant to propranolol (P = n.s.). Mean costs per patient were higher with banding than with propranolol treatment (4,289 +/- 285 vs. 1,425 +/- 460 U.S. dollars, P < 0.001). In conclusion, propranolol and banding are similarly effective in reducing the incidence of variceal bleeding in candidates for LT, but ligation can be complicated by fatal bleeding and is more expensive. Our results suggest that banding should not be utilized as primary prophylaxis in transplant candidates who can be treated with BB.
Norberto
Lorenzo
L
Department of Surgical and Gastroenterological Sciences, 1st Surgical Clinic, Surgical Endoscopy Unit, University of Padova, Padova, Italy. lorenzo.norberto@unipd.it
Polese
Lino
L
Cillo
Umberto
U
Grigoletto
Francesco
F
Burroughs
Andrew K
AK
Neri
Daniele
D
Zanus
Giacomo
G
Boccagni
Patrizia
P
Burra
Patrizia
P
D'Amico
Davide F
DF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008026:Ligation; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control / Q000601:surgery; D011433:Propranolol / Q000627:therapeutic use*; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol