Elective esophageal variceal ligation is performed to decrease the risk of variceal hemorrhage.
Side effects of esophageal variceal ligation include hemorrhage, chest pain, dysphagia, and odynophagia.
Because gastric acid may exacerbate postbanding ulcers and delay healing, proton pump inhibition may decrease side effects associated with esophageal variceal ligation.
Dr Shaheen and colleagues from North Carolina, America, aimed to assess the efficacy of pantoprazole, a proton pump inhibitor, as an adjunct to elective esophageal variceal ligation.
The research team performed a double-blinded, randomized, placebo-controlled trial of pantoprazole after elective esophageal variceal ligation.
Subjects in the pantoprazole arm received 40 mg pantoprazole intravenously after esophageal variceal ligation followed by 40 mg oral pantoprazole for 9 whilst control subjects received intravenous and oral placebo.
| The ulcers in the pantoprazole group were on average half as large as in the placebo group|
The researchers randomized 44 subjects and 42 completed the protocol undergoing endoscopy 10 to 14 days after banding.
The investigators' primary outcomes included the size and number of ulcers and the subjects' reports of dysphagia, chest pain, and heartburn.
At follow-up endoscopy, the mean number of ulcers was similar in the two groups.
The researchers also noted that the ulcers in the pantoprazole group were on average half as large as in the placebo group (37 mm2 vs. 82 mm2) but that chest pain, dysphagia, and heartburn scores were not significantly different.
In addition, the team observed 4 subjects, all in the placebo group, that had adverse outcomes, including 3 who bled from postbanding ulcers and 1 with sepsis.
Dr Shaheen concluded: “Subjects receiving pantoprazole after elective esophageal variceal ligation had significantly smaller postbanding ulcers on follow-up endoscopy than subjects receiving placebo.”
“However, the total ulcer number and patient symptoms were not different between the groups.