A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleeding.
OBJECTIVE
Both medications with beta-blockers and isosorbide-5-mononitrate and endoscopic variceal ligation have been proven plausible in the prevention of variceal rebleeding. However, the relative efficacy and safety of the combined treatment for preventing rebleeding remains unresolved.


METHODS
Patients with history of esophageal variceal bleeding were enrolled. Emergency ligation was performed in patients with acute variceal bleeding. After hemodynamic stability, eligible patients were randomized to either the Medication group, using nadolol plus isorsorbide-5-mononitrate, or the Combined group, receiving banding ligation in addition to medications. Patients in the two groups with rebleeding from esophageal varices were treated with band ligation. The end points were rebleeding from varices or death.


RESULTS
After a median follow up of 23 months, recurrent upper gastrointestinal bleeding developed in 51% in the Medication group and 38% in the Combined group (P = 0.21). Recurrent bleeding from esophageal varices occurred in 26 patients (43%) in the Medication group and in 16 patients (26%) in the Combined group (P = 0.07). Recurrent bleeding from gastroesophageal varices occurred in 48% of Medication group and 28% of Combined group (P = 0.05). The frequency of adverse effects and mortality rates were similar between both groups (P = 0.28).


CONCLUSIONS
Combined ligation with medications was marginally more effective than medication alone in the prevention of gastroesophageal variceal rebleeding with similar adverse effects and mortality.
Lo
Gin-Ho
GH
Digestive Center, E-DA Hospital, Taipei, Taiwan. ghlo@kimo.com
Chen
Wen-Chi
WC
Chan
Hoi-Hung
HH
Tsai
Wei-Lun
WL
Hsu
Ping-I
PI
Lin
Chiun-Ku
CK
Chen
Tai-An
TA
Lai
Kwok-Hung
KH
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives / Q000627:therapeutic use; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; 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