The study was sponsored by a grant from National Science Council, Taiwan (NSC 98–2628-B-075B-001-MY2) and E-DA Hospital (EDPJ 99019).
Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding
Article first published online: 25 MAR 2013
© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 4, pages 684–689, April 2013
How to Cite
Lo, G.-H., Perng, D.-S., Chang, C.-Y., Tai, C.-M., Wang, H.-M. and Lin, H.-C. (2013), Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding. Journal of Gastroenterology and Hepatology, 28: 684–689. doi: 10.1111/jgh.12107
No conflict of interest existed.
Study concept and design, drafting of manuscript: Gin-Ho Lo; Acquisition of data: Daw-Shyong Perng, Chi-Yang Chang, Chi-Ming Tai; Analysis of data and Statistical analysis; Huay-Min Wang, Hui-Chen Lin.
Protocol registration: NCT 01112852; Part of this work was presented at 2011 AASLD.
- Issue published online: 25 MAR 2013
- Article first published online: 25 MAR 2013
- Accepted manuscript online: 27 DEC 2012 05:40AM EST
- Manuscript Accepted: 3 DEC 2012
- National Science Council, Taiwan. Grant Number: NSC 98–2628-B-075B-001-MY2
- E-DA Hospital. Grant Number: EDPJ 99019
- banding ligation;
- proton pump inhibitor;
Endoscopic therapy combined with vasoconstrictor was generally recommended to treat acute variceal bleeding. However, up to 30% of patients may still encounter treatment failure.
This trial was to evaluate the efficacy of combination with endoscopic variceal ligation (EVL) and proton pump inhibitor (PPI) infusion in patients with acute variceal bleeding.
Cirrhotic patients presenting with acute esophageal variceal bleeding were rescued by emergency EVL. Soon after arresting of bleeding varices, eligible subjects were randomized to two groups. Vasoconstrictor group received either somatostatin or terlipressin infusion. PPI group received either omeprazole or pantoprazole. End points were initial hemostasis, very early rebleeding rate, and adverse events.
Sixty patients were enrolled in vasoconstrictor group and 58 patients in PPI group. Both groups were comparable in baseline data. Initial hemostasis was achieved in 98% in vasoconstrictor group and 100% in PPI group (P = 1.0). Very early rebleeding within 48–120 h occurred in one patient (2%) in vasoconstrictor group and one patient (2%) in the PPI group (P = 1.0). Treatment failure was 4% in vasoconstrictor group and 2% in PPI group (P = 0.95). Adverse events occurred in 33 patients (55%) in vasoconstrictor group and three patients (6%) in PPI group (P < 0.001). Two patients in vasoconstrictor group and one patient in PPI group encountered esophageal ulcer bleeding.
After successful control of acute variceal bleeding by EVL, adjuvant therapy with PPI infusion was similar to combination with vasoconstrictor infusion in terms of initial hemostasis, very early rebleeding rate, and associated with fewer adverse events.