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 19 November 2017

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Clinical trial: Nadolol with ligation as prohylaxis for rebleeding

The latest issue of Hepatology reports that nadolol plus ligation reduces the incidence of variceal rebleeding compared with ligation alone and that a combined treatment could lower the probability of variceal recurrence after eradication.

News image

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ß-Blockers and endoscopic variceal ligation have proven to be valuable methods in the prevention of variceal rebleeding.

Dr de la Peña and colleagues from Spain aimed to compare the efficacy of endoscopic variceal ligation combined with nadolol versus endoscopic variceal ligation alone as secondary prophylaxis for variceal bleeding.

The investigative team treated patients who were admitted for acute variceal bleeding during emergency endoscopy with endoscopic variceal ligation or sclerotherapy and received somatostatin for 5 days.

The researchers randomized 80 patients with cirrhosis (alcoholic origin in 66%) to receive endoscopic variceal ligation plus nadolol or endoscopic variceal ligation with a median follow-up period of 16 months.

Adverse effects resulting from nadolol were observed in 11% of the patients
Hepatology

The investigators repeated endoscopic variceal ligation sessions every 10 to 12 days until the varices were eradicated.

The researchers observed that the variceal bleeding recurrence rate was 14% in the endoscopic variceal ligation plus nadolol group and 38% in the endoscopic variceal ligation group.

The research team observed that mortality was similar in both groups.

5 patients (12%) died in the combined therapy group and 4 patients (11%) died in the endoscopic variceal ligation group.

The team noted no significant differences in the number of endoscopic variceal ligation sessions to eradicate varices with 3.2 in the combined therapy group versus 3.5 in the endoscopic variceal ligation alone group.

In addition, the researchers found that the actuarial probability of variceal recurrence at 1 year was lower in the endoscopic variceal ligation plus nadolol group (54%) than in the endoscopic variceal ligation group (77%).

Adverse effects resulting from nadolol were observed in 11% of the patients.

Dr de la Peña concluded, “Nadolol plus endoscopic variceal ligation reduces the incidence of variceal rebleeding compared with endoscopic variceal ligation alone.”

”A combined treatment could lower the probability of variceal recurrence after eradication.”

Hepatology 2005(3);41:572-578
28 February 2005

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