Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 25 May 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Preventing variceal bleeds with endoscopic ligation plus propranolol

Both endoscopic variceal ligation alone and in combination with propranolol are effective in primary prophylaxis of variceal bleeding, however, variceal recurrence is lower if propranolol is added to endoscopic variceal ligation, finds this month's issue of American Journal of Gastroenterology.

News image

fiogf49gjkf04

The role of propranolol in addition to endoscopic variceal ligation in the prevention of first variceal bleed has not been evaluated.

Dr Sarin and colleagues from India conducted a prospective randomized controlled trial comparing endoscopic variceal ligation with propranolol and endoscopic variceal ligation alone in the prevention of first variceal bleed among patients with high-risk varices.

The researchers randomly allocated 144 consecutive patients with high-risk varices to 2 groups.

Group 1 received endoscopic variceal ligation plus propranolol (n = 72) and group 2 underwent endoscopic variceal ligation alone (n = 72).

The research team undertook endoscopic variceal ligation at 2 week intervals until the varices were obliterated.

In the first group, the investigators administered incremental dosages of propranolol, sufficient to reduce heart rate to 55 beats/min or a 25% reduction from baseline and continued this after the obliteration of the varices.

The endpoints of the study were bleeding and death.

The researchers reported that the 2 groups of patients had comparable baseline characteristics.

At follow-up, 4 patients in the combination group and 11 in the single treatment group had recurrence of varices
American Journal of Gastroenterology

The follow-up time for group 1 was a mean of 13 months and 11 months for group 2.

The team noted that the proportion of cirrhotic and noncirrhotic portal hypertension patients in group 1 was 89% and 11%, respectively, and 88% and 13% in group 2.

The frequency of Child's A was 15 in group 1 versus 18 in group 2, Child’s B was 38 versus 35, and Child’s C compared equally with 19 versus 19.

The investigative team observed that the mean daily propranolol dose achieved in groups 1 was 96mg.

In total, the researchers found that 11 patients had bleeds, with 5 in group 1 and 6 in group 2.

The investigators also reported that all patients bled before the obliteration of varices, the actuarial probability of first bleed at 20 months was 7% in group 1 and 11% in group 2.

The team noted that 6 patients died in the combination group and 8 in endoscopic variceal ligation group.

All deaths in group 1 were reported to be nonbleed-related causes, while in group 2 the deaths were bleed related, with an 8% versus 15% probability of death at 20, respectively.

The probability of bleed-related death was comparable between the groups.

The researchers found that at the end of follow-up, 4 patients in group 1 and 11 in group 2 had recurrence of varices.

In addition, the research team noted side effects on propranolol in 22% patients, and in 8% it had to be stopped, but there were no serious complications of endoscopic variceal ligation.

Dr Sarin’s team concluded, “Both endoscopic variceal ligation plus propranolol and endoscopic variceal ligation alone are effective in primary prophylaxis of bleed from high-risk varices.”

“The addition of propranolol does not decrease the probability of first bleed or death in patients on endoscopic variceal ligation.”

“However, the recurrence of varices is lower if propranolol is added to endoscopic variceal ligation.”

Am J Gastroenterol 2005: 100(4): 797
14 April 2005

Go to top of page Email this page Email this page to a colleague

 25 May 2018 
Colorectal cancer–specific mortality
 25 May 2018 
Technology to increase colorectal cancer screening
 25 May 2018 
Post‐operative complications in elderly IBD
 24 May 2018 
Patient-reported outcome measures in IBD trials
 24 May 2018 
Alcohol consumption and outcomes in drug-induced liver injury
 24 May 2018 
Precision medicine for tumors
 23 May 2018 
Management of perianal fistulas in Crohn’s disease
 23 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 23 May 2018 
High body mass index is and ulcerative colitis
 22 May 2018 
Worldwide H.pylori prevalence
 22 May 2018 
PPI and risk of stroke
 22 May 2018 
Online tool predicts bowel dysfunction severity prior to anterior resection
 21 May 2018 
Depressive symptoms in IBD youth
 21 May 2018 
PPI use and cognitive decline
 21 May 2018 
Fecal incontinence and quality of life in IBD
 18 May 2018 
Esophageal dilatation in clinical practice 
 17 May 2018 
IBD and later extraintestinal manifestations
 17 May 2018 
Repeat stool DNA testing
 17 May 2018 
IBS and chronic fatigue following GI infection
 16 May 2018 
Factors associated with fecal incontinence
 16 May 2018 
Diagnostic delay in Crohn's disease
 16 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 15 May 2018 
Guidelines for management of Crohn's
 15 May 2018 
Hep B in the Grey Zone
 15 May 2018 
New therapies for CDI
 14 May 2018 
Blood test for the diagnosis of fibrotic NASH
 14 May 2018 
Outcomes at bariatric centers of excellence
 14 May 2018 
Management of perianal fistulas in Crohn’s
 11 May 2018 
Detection of undiagnosed celiac disease
 11 May 2018 
Alcohol consumption and drug-induced liver injury
 10 May 2018 
Colorectal cancer screening
 10 May 2018 
Fibrosis in patients with chronic hepatitis B
 09 May 2018 
Fecal incontinence
 09 May 2018 
Health problems and IBS
 09 May 2018 
Esophageal dilatation in clinical practice 
 07 May 2018 
Omitting antibiotics in uncomplicated acute diverticulitis
 07 May 2018 
Health problems and IBS
 07 May 2018 
Assessment of diminutive colorectal polyps
 04 May 2018 
National Institutes of Health workshop and obesity
 04 May 2018 
Factors associated with fecal incontinence
 04 May 2018 
Colorectal cancer screening and ethnic inequities
 03 May 2018 
Gastrointestinal ultrasound in IBD
 03 May 2018 
Ultransonography in postsurgical recurrence in Crohn's
 02 May 2018 
Symptom assessment in cirrhotic ascites
 02 May 2018 
Hep C antiviral treatment and liver cancer risk
 02 May 2018 
Chronic Hep B
 01 May 2018 
European guidelines on pancreatic cystic neoplasms
 01 May 2018 
Interferon‐free regimens in Hep C
 01 May 2018 
Age at IBD onset and extraintestinal complications
 30 April 2018 
Formula for preterm infants
 30 April 2018 
Primary antibiotic resistance and sequential therapy for H. pylori
 27 April 2018 
Eastern and western practices for endoscopic resection of colorectal lesions
 27 April 2018 
Anxiety scale for chronic esophageal disease
 27 April 2018 
Disease activity in eosinophilic esophagitis
 26 April 2018 
Obesity and physical activity in diverticulosis
 26 April 2018 
Primary sclerosing cholangitis in the USA
 25 April 2018 
Aspirin and pancreatic cancer
 25 April 2018 
Central mediators of irinotecan-induced steatohepatitis
 25 April 2018 
Neuroimaging in Hep C
 24 April 2018 
Scoring system identifies cancer risk in Barrett's

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us