title: Adding banding ligation is effective as rescue therapy to prevent variceal rebleeding in haemodynamic non-responders to pharmacological therapy.
abstract: BACKGROUND
  It is unknown which is the best therapy to treat haemodynamic non-responders to pharmacological therapy after variceal bleeding.
  
  
  OBJECTIVE
  To evaluate the efficacy of adding banding ligation to drugs to prevent variceal rebleeding in haemodynamic non-responders to drugs.
  
  
  METHODS
  Fifty-three cirrhotic patients with variceal bleeding underwent a hepatic venous pressure gradient (HVPG) measurement 5 days after the episode. Nadolol and nitrates were then titrated to maximum tolerated doses. A second HVPG was taken 14 days later. Responders (HVPG ≤12 mm Hg or ≥20% decrease from baseline) were maintained on drugs and non-responders had banding ligation added to drugs.
  
  
  RESULTS
  Mean follow-up was 28 months. In 5 patients the second HVPG could not be performed because of early rebleeding. The remaining 48 patients were classified as responders (n=24) and non-responders (n=24), who had banding added. No baseline differences were observed between groups. Variceal rebleeding occurred in 12% of the 48 patients whose haemodynamic response was assessed. Responders on drug therapy presented a 16% rebleeding rate, whilst non-responders rescued with banding showed an 8% rebleeding rate. Rebleeding-related mortality was not different between groups.
  
  
  CONCLUSIONS
  In a HVPG-guided strategy, adding banding ligation to drugs is an effective rescue strategy to prevent rebleeding in haemodynamic non-responders to drug therapy.
authors: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain.
authors: Antonio
authors: A
authors: González
authors: Salvador
authors: S
authors: Augustin
authors: Joan
authors: J
authors: Dot
authors: Mercedes
authors: M
authors: Pérez
authors: Monder
authors: M
authors: Abu-Suboh
authors: Alejandro
authors: A
authors: Romero
authors: Antoni
authors: A
authors: Segarra
authors: Josep Ramón
authors: JR
authors: Armengol
authors: Rafael
authors: R
authors: Esteban
authors: Jaime
authors: J
authors: Guardia
authors: Joan
authors: J
authors: Genescà
mesh_terms: D000208:Acute Disease; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives / Q000627:therapeutic use; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use; D055502:Secondary Prevention; D013004:Somatostatin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D009248:Nadolol; D013004:Somatostatin; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate