title: Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding.
abstract: OBJECTIVE
  Rebleeding after an initial oesophageal variceal haemorrhage remains a significant problem despite therapy with band ligation, non-selective β-blockers or a combination of these. Carvedilol is a vasodilating non-selective β-blocker with alpha-1 receptor and calcium channel antagonism. A recent study has suggested it is effective in the prevention of a first variceal bleed. Our aim was to compare oral carvedilol with variceal band ligation (VBL) in the prevention of rebleeding following a first variceal bleed.
  
  
  METHODS
  Patients who were stable 5 days after presentation with a first oesophageal variceal haemorrhage and had not been taking β-blockers were randomised to oral carvedilol or VBL. Patients were followed-up after one week, monthly, then every 3 months. The primary end point was variceal rebleeding on intention-to-treat analysis.
  
  
  RESULTS
  64 patients were randomised, 33 to carvedilol and 31 to VBL. 58 (90.6%) patients had alcohol related liver disease. Age and Child-Pugh score were similar in both groups at baseline. Median follow-up was 26.3 (interquartile range [IQR] 10.2-46.6)months. Compliance was 68% and 65% for carvedilol and VBL respectively (p=0.993) and serious adverse events between the two groups were similar (p=0.968). Variceal rebleeding occurred during follow-up in 12 (36.4%) and 11 (35.5%) patients in the carvedilol and VBL groups, respectively (p=0.857), with 9 (27.3%) and 16 (51.6%) deaths in each group, respectively (p=0.110).
  
  
  CONCLUSIONS
  Carvedilol is not superior to VBL in the prevention of variceal rebleeding. The trend to a survival benefit for patients taking this drug compared with those undergoing banding requires further exploration.
authors: Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK. Electronic address: Adrian.stanley@ggc.scot.nhs.uk.
authors: Adrian J
authors: AJ
authors: Stanley
authors: Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: Sheila
authors: S
authors: Dickson
authors: Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors: Peter C
authors: PC
authors: Hayes
authors: Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: Ewan H
authors: EH
authors: Forrest
authors: Gastroenterology Unit, Gartnavel General Hospital, Glasgow, UK.
authors: Peter R
authors: PR
authors: Mills
authors: Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors: Dhiraj
authors: D
authors: Tripathi
authors: Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors: Joanna A
authors: JA
authors: Leithead
authors: Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors: Kim
authors: K
authors: MacBeth
authors: Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: Lyn
authors: L
authors: Smith
authors: Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: Daniel R
authors: DR
authors: Gaya
authors: Gastroenterology Unit, Southern General Hospital, Glasgow, UK.
authors: Harry
authors: H
authors: Suzuki
authors: Department of Statistics, Strathclyde University, Glasgow, UK.
authors: David
authors: D
authors: Young
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use*; D000077261:Carvedilol; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008026:Ligation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol
keywords: Band ligation; Carvedilol; Portal hypertension; Variceal haemorrhage