title: Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices.
abstract: BACKGROUND
  Very early rebleeding is frequently encountered in patients with acute oesophageal variceal bleeding. A trial was designed to assess the efficacy and safety in patients with no active bleeding at endoscopy, receiving banding ligation association with terlipressin to prevent very early rebleeding.
  
  
  METHODS
  Patients with no active variceal bleeding at endoscopy were evaluated. Eligible patients were randomised to receive terlipressin infusion alone for 5 days (Terlipressin group) or banding ligation plus terlipressin infusion for 2 days (Combined group). Primary endpoints were treatment failure and very early rebleeding.
  
  
  RESULTS
  The terlipressin group was composed of 46 patients and the Combined group was composed of 47 patients. Both groups were comparable in terms of baseline data. Forty-eight-hour haemostasis was achieved in 91% in the Terlipressin group and 98% in the Combined group (p = 0.20). Very early rebleeding within 48-120 h occurred in 7 patients (15%) in the Terlipressin group but not in any patients (0%) in the Combined group (p = 0.006). Treatment failure was 24% in the Terlipressin group and 2% in the Combined group (p = 0.002). Multivariate analysis revealed that treatment (OR 0.081; 95% CI 0.010 to 0.627) was the only predictive factor of very early rebleeding. Blood requirement was significantly lower in the Combined group than in the Terlipressin group. Complications and 6-week survival were similar in both groups.
  
  
  CONCLUSIONS
  Combination of banding ligation and terlipressin infusion for 2 days was superior to only infusion of terlipressin for 5 days in the reduction of very early rebleeding and treatment failure in patients with inactive variceal bleeding at endoscopy.
  
  
  BACKGROUND
  ISRCTN28353453.
authors.affiliation: Digestive Center, E-DA Hospital, Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, I-Shou University, Taipei, Taiwan. ghlo@kimo.com
authors.forename: G-H
authors.initials: GH
authors.lastname: Lo
authors.forename: W-C
authors.initials: WC
authors.lastname: Chen
authors.forename: H-M
authors.initials: HM
authors.lastname: Wang
authors.forename: C-K
authors.initials: CK
authors.lastname: Lin
authors.forename: H-H
authors.initials: HH
authors.lastname: Chan
authors.forename: W-L
authors.initials: WL
authors.lastname: Tsai
authors.forename: L-C
authors.initials: LC
authors.lastname: Cheng
authors.forename: H-C
authors.initials: HC
authors.lastname: Yu
authors.forename: F-W
authors.initials: FW
authors.lastname: Tsay
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; D015996:Survival Rate; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin