Propranolol associated with endoscopic band ligation reduces recurrence of esophageal varices for primary prophylaxis of variceal bleeding: a randomized-controlled trial.
OBJECTIVE
The aim of this study was to compare the recurrence of esophageal varices (EVs) after endoscopic band ligation (EBL) associated with propranolol (PP) versus EBL alone.


METHODS
Sixty-six cirrhotic outpatients (EBL group, n=32 and EBL+PP group, n=34) with high-risk EVs without previous bleeding were studied.


METHODS
The primary outcome was recurrence of EV. The secondary outcomes were EV eradication, bleeding before EV eradication, mortality, and adverse events.


RESULTS
Demographic characteristics and the initial endoscopic findings were similar. EV eradication was achieved in all patients. Three patients presented gastrointestinal bleeding before variceal eradication, two in the EBL group and one in the EBL+PP group (P=0.13). Six patients died (liver failure), two in the EBL group and four in the EBL+PP group (P=0.27). Twelve (38%) patients in the EBL group and three (9%) patients in the EBL+PP group had variceal recurrence. The risk of recurrence of EVs after eradication was significantly higher among patients in the EBL group (P=0.003).


CONCLUSIONS
EBL alone and EBL+PP were effective in the primary prophylaxis of bleeding from EVs in cirrhotic patients (EV eradication, bleeding before EV eradication, mortality, and adverse events were similar in both groups). However, variceal recurrence was lower in the EBL+PP group than band ligation alone.
aDivision of Gastroenterology, Federal University of São Paulo bEndoscopy Division, Fleury Medicina e Saúde cEndoscopy Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Danielle Queiroz
DQ
Bonilha
Luciano
L
Lenz
Lucianna Motta
LM
Correia
Rodrigo Azevedo
RA
Rodrigues
Gustavo Andrade
GA
de Paulo
Angelo Paulo
AP
Ferrari
Ermelindo
E
Della Libera
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications; D017093:Liver Failure / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol