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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 survival in patients with propranolol alone versus EVL plus propranolol (P=0.789).
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Figure 2: Wilcoxon plot showing the cumulative probability of survival in patients with propranolol alone versus EVL plus propranolol (P=0.789).

Mentions: There were 20 deaths in Gr1 (6.1%) and 12 deaths in Gr2 (6.9%). Deaths from variceal bleeding occurred in 2 (0.6%) in Gr1 as compared to none in Gr2. Other causes of death were ascribed to end-stage liver disease (hepatic failure 4, hepatic encephalopathy 12, hepatorenal syndrome 3), infection (pneumonia 3, sepsis 3, spontaneous bacterial peritonitis 2), and lower gastrointestinal bleeding 3 (Table 4). 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). Overall survival plot for the two groups is shown in Figure 2. Univariate analysis was performed to ascertain predictive factors of deaths by using baseline demographic, clinical, endoscopic characteristics, and the method of primary prophylaxis. Of all the factors analyzed, age over 50 (P=0.000), and Child-Pugh class (P=0.000) were associated with a high probability of deaths (Table 5). On multivariate analysis by Cox regression, 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) were identified as independent prognostic factors for mortality (Table 6).


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 survival in patients with propranolol alone versus EVL plus propranolol (P=0.789).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Wilcoxon plot showing the cumulative probability of survival in patients with propranolol alone versus EVL plus propranolol (P=0.789).
Mentions: There were 20 deaths in Gr1 (6.1%) and 12 deaths in Gr2 (6.9%). Deaths from variceal bleeding occurred in 2 (0.6%) in Gr1 as compared to none in Gr2. Other causes of death were ascribed to end-stage liver disease (hepatic failure 4, hepatic encephalopathy 12, hepatorenal syndrome 3), infection (pneumonia 3, sepsis 3, spontaneous bacterial peritonitis 2), and lower gastrointestinal bleeding 3 (Table 4). 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). Overall survival plot for the two groups is shown in Figure 2. Univariate analysis was performed to ascertain predictive factors of deaths by using baseline demographic, clinical, endoscopic characteristics, and the method of primary prophylaxis. Of all the factors analyzed, age over 50 (P=0.000), and Child-Pugh class (P=0.000) were associated with a high probability of deaths (Table 5). On multivariate analysis by Cox regression, 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) were identified as independent prognostic factors for mortality (Table 6).

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