Endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleed: Preliminary report of a randomized controlled trial
Article first published online: 19 APR 2002
Journal of Gastroenterology and Hepatology
Volume 14, Issue 3, pages 220–224, March 1999
How to Cite
De, B., Ghoshal, U., Das, T., Santra, A. and Biswas, P. (1999), Endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleed: Preliminary report of a randomized controlled trial. Journal of Gastroenterology and Hepatology, 14: 220–224. doi: 10.1046/j.1440-1746.1999.01800.x
- Issue published online: 19 APR 2002
- Article first published online: 19 APR 2002
- endoscopic sclerotherapy;
- portal hypertension;
Background: Prevention of variceal bleeding, a major cause of morbidity and mortality, is an important goal in the management of patients with portal hypertension (PHT). Although propranolol has been found useful in preventing the first episode of variceal bleeding (primary prophylaxis) in cirrhotic PHT, it has limitations which include side effects, contraindications, non-compliance and failure in some patients. Endoscopic variceal ligation (EVL) has not been used for primary prophylaxis.
Methods: Thirty cirrhotic patients with PHT, grade III to IV oesophageal varices, hepatic venous pressure gradient ≥ 12 mmHg and no prior history of upper gastrointestinal bleeding were randomized to receive propranolol (to reduce their pulse rate by 25% from baseline, n = 15) and EVL (weekly to fortnightly until variceal eradication, n = 15). The two groups were comparable. All the patients in EVL group had variceal eradication during 3.8 ± 2.2 sessions.
Results: There was no major complication or interval bleeding. During a follow-up period of 17.6 ± 4.7 months, varices recurred in three, two of which bled (successfully treated by EVL). In contrast, during this period of follow up one patient in the propranolol group had variceal bleeding (P = NS). Side effects of propranolol included symptomatic bradycardia requiring reduction of dose in one of 15 patients.
Conclusions: Although sample size in this study is small, it seems that EVL may be a good option for primary prophylaxis for variceal bleeding in patients with cirrhotic PHT; further studies on a larger number of patients and longer follow up are required.