Writing in the July issue of the journal Hepatology, researchers from Germany compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding.
They compared the two methods of intervention in a randomized controlled multicenter trial, using 152 cirrhotic patients with two or more esophageal varices of diameter greater than 5 mm, who had no prior bleeding.
The patients were randomized to VBL (n = 75) or PPL (n = 77), with the groups well matched with respect to baseline characteristics (age 56 ± 10 years, alcoholic etiology 51%, Child-Pugh score 7.2 ± 1.8).
The mean follow-up was 34 ± 19 months and data were analyzed on an intention-to-treat basis.
Neither bleeding incidence nor mortality differed to any extent between the two groups, with variceal bleeding occurring in 25% of the VBL group and 29% of the PPL group.
After 2 years, the actuarial risks of bleeding were 20% (VBL) and 18% (PPL).
Fatal bleeding was observed in 12% (VBL) and 10% (PPL) of patients and was associated with the ligation procedure in 2 patients (2.6%).
Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL).
A total of 25% of patients had to withdraw from PPL treatment, with 16% withdrawing due to side effects.
The authors conclude that VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding, and that VBL should be offered to those patients who cannot tolerate long-term PPL treatment.