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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 - Clin Mol Hepatol (2014)

Bottom Line: 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).EVL plus propranolol is more effective than propranolol alone in the prevention of the first variceal bleeding in patients with liver cirrhosis.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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.

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Related in: MedlinePlus

Wilcoxon plot showing the cumulative probability of variceal bleeding in patients with propranolol alone versus EVL plus propranolol (P=0.04).
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Figure 1: Wilcoxon plot showing the cumulative probability of variceal bleeding in patients with propranolol alone versus EVL plus propranolol (P=0.04).

Mentions: Variceal bleeding occurred in 32 (9.7%) patients in Gr1 and 6 (3.4%) patients in Gr2. Of total 38 bleedings, 28 (73.7%) occurred in Child's A, 3 (7.9%) in Child's B, and 7 (18.4%) in Child's C cirrhosis. The Gehan's generalized Wilcoxon method was used to estimate probability of bleeding. The patients with propranolol plus EVL had a lower probability of variceal bleeding. The cumulative probability of bleeding at 120 months was 13% in Gr1 versus 4% in Gr2 (P=0.04), indicating that the patients with EVL plus propranolol had a lower probability of variceal bleeding compared to propranolol alone (Fig. 1). Univariate analysis was performed to ascertain predictive factors of variceal bleeding by using baseline demographic, clinical, endoscopic characteristics, and the method of primary prophylaxis. Of all the factors analyzed, Child-Pugh class (P=0.012), variceal size (P=0.010), red color signs (P=0.040), and the method of primary prophylaxis (P=0.012) were associated with a high probability of variceal bleeding (Table 2). On multivariate analysis by binary logistic regression, red color signs (OR 2.962, P=0.007) and the prophylactic method of EVL plus propranolol (OR 0.160, P=0.000) were significantly related with esophageal variceal bleeding (Table 3).


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 - Clin Mol Hepatol (2014)

Wilcoxon plot showing the cumulative probability of variceal bleeding in patients with propranolol alone versus EVL plus propranolol (P=0.04).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197177&req=5

Figure 1: Wilcoxon plot showing the cumulative probability of variceal bleeding in patients with propranolol alone versus EVL plus propranolol (P=0.04).
Mentions: Variceal bleeding occurred in 32 (9.7%) patients in Gr1 and 6 (3.4%) patients in Gr2. Of total 38 bleedings, 28 (73.7%) occurred in Child's A, 3 (7.9%) in Child's B, and 7 (18.4%) in Child's C cirrhosis. The Gehan's generalized Wilcoxon method was used to estimate probability of bleeding. The patients with propranolol plus EVL had a lower probability of variceal bleeding. The cumulative probability of bleeding at 120 months was 13% in Gr1 versus 4% in Gr2 (P=0.04), indicating that the patients with EVL plus propranolol had a lower probability of variceal bleeding compared to propranolol alone (Fig. 1). Univariate analysis was performed to ascertain predictive factors of variceal bleeding by using baseline demographic, clinical, endoscopic characteristics, and the method of primary prophylaxis. Of all the factors analyzed, Child-Pugh class (P=0.012), variceal size (P=0.010), red color signs (P=0.040), and the method of primary prophylaxis (P=0.012) were associated with a high probability of variceal bleeding (Table 2). On multivariate analysis by binary logistic regression, red color signs (OR 2.962, P=0.007) and the prophylactic method of EVL plus propranolol (OR 0.160, P=0.000) were significantly related with esophageal variceal bleeding (Table 3).

Bottom Line: 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).EVL plus propranolol is more effective than propranolol alone in the prevention of the first variceal bleeding in patients with liver cirrhosis.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus