Comparison between the Prophylactic Endoscopic Variceal Ligation and Propranolol Administration for Prevention of First Bleeding in Cirrhotic Patients with High-risk Esophageal Varices: a Randomized Prospective Study

Song, Il Han; Kim, In Ho; Choi, Jeong; Lyu, Sen; Roe, Im Hwan

Abstract

BACKGROUND/AIMS: The prophylactic management for first bleeding in cirrhotic patients with esophageal varices is still debated. The aim of present study was to compare the outcomes of the prophylactic endoscopic variceal ligation (EVL) and propranolol administration for prevention of first bleeding in cirrhotic patients with high-risk esophageal varices.
METHODS
We performed a prospective, randomized trial for 61 cirrhotic patients with high-risk esophageal varices. The patients were divided into two groups: the EVL-treated group (31 cases) and the propranolol-administrated group (30 cases). Patients with history of esophageal variceal bleeding, hepatocellular carcinoma, and cardiopulmonary diseases were excluded in this study.
RESULTS
In 6 (19.4%) of the EVL-treated group and 7 (23.3%) of the propranolol-administered group, gastrointestinal bleeding occurred during follow-up. The cumulative variceal bleeding rates in the EVL group at 2 weeks, 6 months, 1 year was 3.2, 3.2, 9.7%, respectively, while that in propranolol group was 0, 10, 20%. The cumulative survival rate in EVL group at 6, 12, 18 months was 93.5, 90.3, 83.9%, respectively, while that in propranolol group was 90, 83.3, 73.3%.
CONCLUSIONS
This study showed that in cirrhotic patients with high-risk esophageal varices, the prophylactic EVL tends to decrease the incidence of first variceal bleeding and death, compared with the -blocker administration. However, to confirm these results, the statistical significance for outcomes of the both treatment modalities should be assessed through the long term follow-up.