A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage.
Endoscopic variceal ligation (EVL) and nonselective beta-blockers (hereafter just called beta-blockers) are both effective for primary prophylaxis for variceal hemorrhage; however, the route of administration and side effects of these treatments are distinct. The objective of this study was to examine predicted preferences of patients and physicians for the primary prevention of variceal hemorrhage. Untreated patients with newly diagnosed esophageal varices and practicing gastroenterologists were enrolled in this study. Patients with contraindications to either EVL or beta-blockers were excluded. Predicted preferences for treatment were evaluated with an interactive computer task designed to elicit subjects' trade-offs related to the route of administration, risk of fatigue, sexual dysfunction, dysphagia, shortness of breath and/or hypotension, procedure-related bleeding, and perforation. Fifty-three patients and 61 physicians were enrolled. Thirty-four (64%) patients and 35 (57%) physicians preferred EVL over beta-blockers. Patients' predicted preferences were most strongly influenced by the risks of shortness of breath or hypotension, fatigue, and procedure-related bleeding, whereas physicians placed greater importance on procedure-related bleeding, sexual dysfunction, and perforation. Forty-eight patients were prescribed beta-blockers, two were not given prophylaxis, and three were lost to follow-up.


CONCLUSIONS
Predicted treatment preferences among both patients and physicians for primary prophylaxis of variceal hemorrhage vary significantly. Physicians in this study preferring EVL stated that they prescribe beta-blockers as first-line therapy in order to remain compliant with guidelines. Physicians should discuss both EVL and beta-blockers with patients requiring primary prophylaxis for variceal hemorrhage. Future guidelines should incorporate individual patient preferences.
Longacre
Anna V
AV
Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Imaeda
Avlin
A
Garcia-Tsao
Guadalupe
G
Fraenkel
Liana
L
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
D000319:Adrenergic beta-Antagonists