title: Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension.
abstract: OBJECTIVE
  Variceal bleeding increases morbidity and mortality among patients with noncirrhotic portal hypertension (NCPH). Blockers of β-adrenergic receptor signaling and endoscopic variceal ligation (EVL) have been used to prevent recurrence of bleeding, based on data from cirrhotic patients. We compared the efficacy and safety of the β-blocker propranolol with that of EVL in preventing the recurrence of variceal bleeding in patients with NCPH.
  
  
  METHODS
  Consecutive patients with NCPH with a history of variceal bleeding in the past 6 weeks were assigned randomly to groups treated every 3 weeks with EVL (n = 51) or propranolol (until they had a resting heart rate of 55 beats per minute or to a maximum of 320 mg/day; n = 50). Primary end points were recurrence of variceal bleeding or death. Secondary end points were complications of EVL in patients given EVL, variceal eradication after EVL, variceal recurrence after EVL, or a decrease in variceal grade in patients given propranolol.
  
  
  RESULTS
  After a median follow-up period of 23 months, rates of recurrence of bleeding were similar between the groups (EVL, 23.5%; propranolol, 18%; P = .625). The actuarial probability of remaining free of bleeding recurrence was similar between the groups. No deaths occurred in either group. Of the patients given propranolol, 47% had a decrease in the grade of varices and none experienced bleeding. Adverse events were minor and comparable between groups (EVL, 12%; propranolol, 18%; P = .635).
  
  
  CONCLUSIONS
  EVL was not more effective than the β-blocker propranolol for the secondary prophylaxis of variceal bleeding in patients with NCPH.
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India. shivsarin@gmail.com
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
authors.forename: Nitin
authors.initials: N
authors.lastname: Gupta
authors.forename: Sanjeev Kumar
authors.initials: SK
authors.lastname: Jha
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Smruti Ranjan
authors.initials: SR
authors.lastname: Mishra
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008026:Ligation; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol