Standard care for prevention of first esophageal variceal hemorrhage is β-blockade, but this may be ineffective or unsafe.
Dr Jensen and team from California compared endoscopic banding with propranolol for prevention of first variceal hemorrhage.
The research team designed a multicenter, prospective trial, where 62 patients with cirrhosis and high-risk esophageal varices were randomized to propranolol or banding.
The dose of propranolol was titrated to reduce resting pulse by 25% or more, and banding was performed monthly until varices were eradicated.
The researchers followed up the patients on the same schedule for a mean duration of 15 months.
The primary end point was treatment failure, defined by the team as the development of endoscopically documented variceal hemorrhage or a severe medical complication requiring discontinuation of therapy.
The investigators estimated direct costs from Medicare reimbursements and fixed or variable charges for services up to treatment failure.
Background variables of the treatment groups were similar.
The investigative team reported that the trial was stopped early after an interim analysis showing that the failure rate of propranolol was significantly higher than that of banding.
|Mortality rate in the propranolol group was 4 in 31 patients compared with none in the banding group|
Significantly more propranolol than banding patients had esophageal variceal hemorrhage.
The researchers also found that the cumulative mortality rate was significantly higher in the propranolol with 4 out of 31 patients, than in the banding group with none.
The team observed that the direct costs of care were not significantly different between the two treatments.
Dr Jensen’s team concluded, “For patients with cirrhosis with high-risk esophageal varices and no history of variceal hemorrhage, propranolol-treated patients had significantly higher failure rates.”
“Propranolol-treated patients also had higher rates of first esophageal varix hemorrhage, and cumulative mortality than banding patients.”
“However, the direct costs of medical care were not significantly different.”