Improved survival in patients receiving medical therapy as compared with banding ligation for the prevention of esophageal variceal rebleeding.
Both medical therapy and endoscopic variceal ligation (EVL) have proven to be comparable in the prevention of variceal rebleeding. However, the long-term results are still lacking. Our previous study enrolled 121 patients with history of esophageal variceal bleeding and randomized to receive EVL (EVL group, 60 patients) or drug therapy, nadolol plus isosorbide-5-mononitrate (N+I) (N+I group, 61 patients) to prevent variceal rebleeding. The EVL group received ligation regularly until variceal obliteration. The N+I group received N+I during the study period. Patients were followed for up to 8 years. After a median follow-up of 82 months, recurrent upper gastrointestinal bleeding developed in 28 patients (47%) in the EVL group and 49 patients (80%) in the N+I group (P = 0.001). Recurrent bleeding from esophageal varices occurred in 18 patients (30%) in the EVL group and 39 patients (64%) in the N+I group. The actuarial probability of rebleeding from esophageal varices was lower in the EVL group (P = 0.001). A total of 42 patients of the EVL group and 30 patients of the N+I group died (P = 0.013). The multivariate Cox analysis indicated that age, serum albumin, presence of encephalopathy, and treatment were the factors predictive of mortality.


CONCLUSIONS
Our long-term follow-up study showed that combination of N+I therapy was inferior to banding ligation in the reduction of variceal rebleeding, but with enhanced survival.
Lo
Gin-Ho
GH
Department of Medical Education and Research, Division of Gastroenterology, National Yang-Ming University, Taipei, Taiwan, Republic of China. ghlo@isca.vghks.gov.tw
Chen
Wen-Chi
WC
Lin
Chiun-Ku
CK
Tsai
Wei-Lun
WL
Chan
Hoi-Hung
HH
Chen
Tai-An
TA
Yu
Hsien-Chung
HC
Hsu
Ping-I
PI
Lai
Kwok-Hung
KH
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use*; D055502:Secondary Prevention; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate