Clin Mol Hepatol.  2014 Sep;20(3):283-290. 10.3350/cmh.2014.20.3.283.

The comparison of esophageal variceal ligation plus propranolol versus propranolol alone for the primary prophylaxis of esophageal variceal bleeding

• Je D
• Paik YH
• Gwak GY
• Choi MS
• Lee JH
• Koh KC
• Paik SW
• Yoo BC

• KMID: 2069765
• DOI: http://doi.org/10.3350/cmh.2014.20.3.283

Abstract

BACKGROUND/AIMS
To investigate the efficacy and longterm outcome of esophageal variceal ligation (EVL) plus propranolol in comparison with propranolol alone for the primary prophylaxis of esophageal variceal bleeding.
METHODS
A total of 504 patients were retrospectively enrolled in this study. 330 patients were in propranolol group (Gr1) and 174 patients were in EVL plus propranolol group (Gr2). The endpoints of this study were esophageal variceal bleeding and mortality. Association analyses were performed to evaluate bleeding and mortality between Gr1 and Gr2.
RESULTS
EVL was more applied in patients with high risk, such as large-sized varices (F2 or F3) or positive red color signs. Total 38 patients had bleeds, 32 in Gr1 and 6 in Gr2. The cumulative probability of bleeding at 120 months was 13% in Gr1 versus 4% in Gr2 (P=0.04). The predictive factors of variceal bleeding were red color signs (OR 2.962, P=0.007) and the method of propranolol plus EVL (OR 0.160, P=0.000). 20 patients died in Gr1 and 12 in Gr2. Mortality rates are similar in the two groups compared, 6.7% in Gr1 and 6.9% in Gr2. The cumulative probability of mortality at 120 months was not significantly different in the two groups (7% in Gr1, 12% in Gr2, P=0.798). The prognostic factors for mortality were age over 50 (OR 5.496, P=0.002), Child-Pugh class B (OR 3.979, P=0.001), and Child-Pugh class C (OR 10.861, P=0.000).
CONCLUSIONS
EVL plus propranolol is more effective than propranolol alone in the prevention of the first variceal bleeding in patients with liver cirrhosis.

Keyword

Esophageal varices; Bleeding; Prophylaxis; Ligation; Propranolol

MeSH Terms

Adrenergic beta-Antagonists/*therapeutic use
Adult
Aged
Esophageal and Gastric Varices/*pathology
Female
Follow-Up Studies
Gastrointestinal Hemorrhage/*drug therapy/mortality/surgery
Humans
Ligation
Liver Cirrhosis/etiology
Logistic Models
Male
Middle Aged
Odds Ratio
Proportional Hazards Models
Propranolol/*therapeutic use
Retrospective Studies
Severity of Illness Index
Survival Rate
Adrenergic beta-Antagonists
Propranolol