Azygoportal disconnection or a combination of non-selective beta-blockers and endoscopic variceal ligation to prevent recurrent bleeding in patients with cirrhosis awaiting transplantation

Abstract

Objective: to compare the efficacy of azygoportal disconnection (APD) surgery and a combination between endoscopic variceal ligation (EVL) and non-selective beta-blockers (NSBBs) in the prevention of recurrent variceal bleeding (RVB). To compare the incidence of gastric variceal bleeding (GVB) after these manipulations in patients with decompensated cirrhosis waitlisted for liver transplantation (LTx).Materials and methods. Patients with decompensated cirrhosis underwent RVB prophylaxis by APD surgery or by a combination of EVL and NSBBs.Results. There were no significant differences in clinical, laboratory, demographic parameters, MELD-Na and Child–Turcotte–Pugh (CTP) scores, and frequencies of medium- and large-sized varicose veins among subgroups of patients with different RVB prophylaxis methods Patients with decompensated cirrhosis who underwent APD surgery did not experience any RVB episodes during the LTx waiting period, which lasted two years from the start of bleeding prophylaxis. In the same period, RVB occurred in 100% of cases in the EVL plus NSBBs group. Using the Kaplan–Meier method with the Log-Rank test, a significant difference (p = 0.0001) was found between the proportions of non-RVB patients in the APD and EVL + NSBBs groups. In the meantime, 48.1% of patients who had APD surgery developed GVB, while 100% of cases in EVL + NSBBs group did not. The Kaplan–Meier method with the Log-Rank test revealed a significant difference (p = 0.0001) between the proportion of non-GVB patients in EVL + NSBBs and APD groups.