Endoscopic variceal banding has not been compared with hepatic venous pressure-guided medical therapy (beta-blockers and nitrates), for the prevention of variceal rebleeding.
In this study, a team of researchers from England and Italy assessed 102 patients who had cirrhosis and a recent esophageal variceal bleed.
These patients were randomly assigned to either endoscopic banding or medical therapy.
The team measured the hepatic venous pressure gradient in all patients at baseline, at 3 months (drug arm), and at yearly intervals (all patients).
In this study, the primary end points were death or rebleeding.
The team found the 2 groups to be well matched.
|Rebleeding at 1 year:|
- Drug arm = 44%
- Banding arm = 54%
They also found that 51% were Pughs C, with a median Pughs score of 9.5.
During the course of the study, 19 patients rebled in the drug arm, whereas 27 rebled in the banding arm.
Furthermore, at 1 year, 44% of patients had bled in the drug arm compared to 54% in the banding arm (p = 0.25).
However, 32% of medical therapy patients had died at 1 year compared to 23% of banding patients (p = 0.97).
Dr Patch's team concluded that, "In the prevention of variceal rebleeding, beta-blockers ± nitrates are as effective as endoscopic banding".
In a related editorial in the same publication, Drs Roberto Groszmann and Guadalupe Garcia-Tsao, discuss the treatment of variceal hemorrhage, as a complication of chronic liver disease.
Clinical trials have confirmed that new portal hypotensive agents, and the predictive value of serial hepatic venous pressure gradient measurements, are a powerful tool in the management of portal hypertension, they conclude.