title: Primary prophylaxis of variceal bleeding in cirrhotic patients: a cohort study.
abstract: BACKGROUND
  Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However, it has been suggested that these patients may respond poorly to band ligation.
  
  
  OBJECTIVE
  We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers.
  
  
  METHODS
  One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group B) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers.
  
  
  RESULTS
  Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A, 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%).
  
  
  CONCLUSIONS
  Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers.
authors.affiliation: Department of Medical Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dell'Era
authors.forename: J Cubero
authors.initials: JC
authors.lastname: Sotela
authors.forename: F M
authors.initials: FM
authors.lastname: Fabris
authors.forename: G
authors.initials: G
authors.lastname: Petazzi
authors.forename: R
authors.initials: R
authors.lastname: Reati
authors.forename: F
authors.initials: F
authors.lastname: Iannuzzi
authors.forename: A
authors.initials: A
authors.lastname: Nicolini
authors.forename: M G
authors.initials: MG
authors.lastname: Rumi
authors.forename: R
authors.initials: R
authors.lastname: de Franchis
authors.forename: M
authors.initials: M
authors.lastname: Primignani
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000075202:Contraindications; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged
chemical_list: D000319:Adrenergic beta-Antagonists