title: Endoscopic ultrasonography assessment of para-esophageal varices predicts efficacy of propranolol in preventing recurrence of esophageal varices.
abstract: BACKGROUND
  Volume of para-esophageal varices (PEV) correlates with esophageal varices recurrence. The effect of propranolol on volumetric change of PEV has not been studied. The relation between EV recurrence and volumetric change of PEV in patients undergoing endoscopic variceal ligation (EVL) with and without propranolol are studied.
  
  
  METHODS
  Sixty-six patients who achieved EV eradication by primary EVL were randomly allocated to a propranolol group (n = 33) or control group (n = 33). The endpoints of the study were EV recurrence and volumetric change of PEV assessed by using endoscopic ultrasonography (EUS) at 3-month intervals for 2 years.
  
  
  RESULTS
  The cumulative probability of recurrence at two years was 28% in the propranolol group (n = 9) and 68% in the control group (n = 20) (p = 0.005, log-rank test). Difference of the volumetric change of PEV became significant as early as at the third month [-0.12 (-0.38-0.34) vs. 0.14 (-0.06-0.57), p < 0.001] between the two groups. Regression of PEV was achieved in 20 patients of the propranolol group at a median time of three months (range 3-12 months), and no EV recurrence was found at the end of follow-up for two years. On multivariate analysis, the volumetric change of PEV at the third month and use of propranolol were determinants of EV recurrence.
  
  
  CONCLUSIONS
  Propranolol may reduce both EV recurrence rate and volume of PEV in patients achieving endoscopic eradication. Regression of PEV is a predictor of durable eradication of EV without recurrence in patients using propranolol. EUS is an objective and useful tool to measure PEV and predict recurrence of EV.
authors.affiliation: School of Medicine, National Yang Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan (ROC), gi1687@hotmail.com.
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.forename: Ping-Hsien
authors.initials: PH
authors.lastname: Chen
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.forename: Chen-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D019160:Endosonography / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol