The comparison of esophageal variceal ligation plus propranolol versus propranolol alone for the primary prophylaxis of esophageal variceal bleeding.
10.3350/cmh.2014.20.3.283
- Author:
Dongmo JE
1
;
Yong Han PAIK
;
Geum Youn GWAK
;
Moon Seok CHOI
;
Joon Hyeok LEE
;
Kwang Cheol KOH
;
Seung Woon PAIK
;
Byung Chul YOO
Author Information
1. Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dmoje@daum.net
- Publication Type:Original Article ; Comparative Study
- Keywords:
Esophageal varices;
Bleeding;
Prophylaxis;
Ligation;
Propranolol
- MeSH:
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
- From:Clinical and Molecular Hepatology
2014;20(3):283-290
- CountryRepublic of Korea
- Language:English
-
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.
