Clin Mol Hepatol.  2013 Sep;19(3):280-287. 10.3350/cmh.2013.19.3.280.

The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

• Choi MH
• Kim YS
• Kim SG
• Lee YN
• Seo YR
• Kim MJ
• Lee SH
• Jeong SW
• Jang JY
• Kim HS
• Kim BS

• KMID: 1705206
• DOI: http://doi.org/10.3350/cmh.2013.19.3.280

Abstract

BACKGROUND/AIMS
The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl(R). However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study.
METHODS
Ninety-three patients at Soonchunhyang University Hospital with acute GVB who received GVO using Histoacryl(R) were enrolled between June 2001 and March 2010. Among these, 42 patients underwent GVO alone (GVO group) and 51 patients underwent GVO with adjuvant BB therapy (GVO+BB group). This study was intended for patients in whom a desired heart rate was reached. The rates of rebleeding-free survival and overall survival were calculated for the two study groups using Kaplan-Meyer analysis and Cox's proportional-hazards model.
RESULTS
The follow-up period after the initial eradication of gastric varices was 18.14+/-25.22 months (mean+/-SD). During the follow-up period, rebleeding occurred in 10 (23.8%) and 21 (41.2%) GVO and GVO+BB patients, respectively, and 39 patients died [23 (54.8%) in the GVO group and 16 (31.4%) in the GVO+BB group]. The mean rebleeding-free survival time did not differ significantly between the GVO and GVO+BB groups (65.40 and 37.40 months, respectively; P=0.774), whereas the mean overall survival time did differ (52.54 and 72.65 months, respectively; P=0.036).
CONCLUSIONS
Adjuvant BB therapy after GVO using Histoacryl(R) for the first acute episode of GVB could decrease the mortality rate relative to GVO alone. However, adjuvant BB therapy afforded no benefit for the secondary prevention of rebleeding in GV.

Keyword

Gastric varices; Beta-blocker; Secondary prevention

MeSH Terms

Adrenergic beta-Antagonists/*therapeutic use
Adult
Aged
Enbucrilate/therapeutic use
Endoscopy, Digestive System
Esophageal and Gastric Varices/*drug therapy
Female
Follow-Up Studies
Gastrointestinal Hemorrhage/mortality/*therapy
Heart Rate
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Propranolol/therapeutic use
Risk Factors
Severity of Illness Index
Adrenergic beta-Antagonists
Enbucrilate
Propranolol