Propranolol, isosorbide mononitrate and endoscopic band ligation - alone or in varying combinations for the prevention of esophageal variceal rebleeding.
OBJECTIVE
To compare the efficacy of propranolol, propranolol with nitrate, band ligation, and band ligation with propranolol and nitrate for the prevention of esophageal variceal rebleeding.


METHODS
A prospective randomized trial.


METHODS
Department of Gastroenterology and Hepatology, Sheikh Zayed Hospital, Lahore, from November 2003 to July 2005.


METHODS
One hundred and sixty cirrhotic patients with esophageal variceal bleeding were randomized to four treatment groups (propranolol, propranolol plus isosorbide mononitrate, band ligation, band ligation plus propranolol and nitrate) with 40 patients in each group. Patients were followed for 6 months after the enrolment of last patient. Primary end points were recurrence of esophageal variceal bleeding and death. Treatment complications were noted.


RESULTS
Four treatment groups were comparable regarding baseline characteristics. Esophageal variceal rebleeding occurred in 22% patients in band ligation plus drugs group, 26% patients in drug combination group, 31% patients in banding group and 38% patients in propranolol group (p=0.41). Difference in mortality rates was also not significant.


CONCLUSIONS
There was no significant difference between treatment groups in prevention of esophageal variceal rebleeding.
Ahmad
Irfan
I
Medical Unit 1, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. uhirfan@yahoo.com
Khan
Anwaar A
AA
Alam
Altaf
A
Butt
Arshad Kamal
AK
Shafqat
Farzana
F
Sarwar
Shahid
S
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008026:Ligation; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D055502:Secondary Prevention; D014665:Vasodilator Agents / Q000627:therapeutic use*; D055815:Young Adult
D014665:Vasodilator Agents; D011433:Propranolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate