Comparative Evaluation of Endoscopic Variceal Band Ligation and Carvedilol for Prevention of First Esophageal Variceal Bleed in High Risk Cirrhotics.

Abstract

BACKGROUND & AIMS: Endoscopic variceal ligation (EVL), and non-selective beta blockers (NSBBs) are the favourable options for primary prophylaxis of variceal bleed. Carvedilol causes higher reduction in portal pressure in comparison to other NSBBs. Our aim was to compare the outcomes of variceal bleed prevention by EVL, and carvedilol in high risk cirrhosis. 
 
 METHODS: Our randomised trial evaluated high risk cirrhotic patients at risk of bleeding without a past history of variceal bleed. Included patients underwent screening endoscopy, and those having high risk varices (grade III/IV) and/or showing red color signs were randomised (1:1 ratio) to receive either EVL or Carvedilol. Follow up was done after 1 year. Primary endpoint was first variceal bleed, and secondary end points included overall mortality due to any cause. 
 
 RESULTS: We studied 52 patients with 26 patients in each group with similar baseline characteristics. Majority of patients were Child-Pugh Class B followed by Child-Pugh Class A. Carvedilol group had lower variceal bleeding than EVL group (7.6% vs 19.2%, P=0.41) without any difference in mortality. Overall mortality in EVL arm was 15.38% (n=4), and Carvedilol arm was 11.53% (n=3). Bleeding related mortality was same in both groups i.e. 3.84% (n=1). One patient receiving Carvedilol developed syncope warranting cessation of therapy, otherwise well tolerated. Two patients who underwent EVL had post procedure bleeding. 
 
 CONCLUSIONS: We concluded similar or possibly higher efficacy of Carvedilol as prophylactic agent for variceal haemorrhage. Limitation of our study includes a smaller sample size. A higher patient data will help confirm our results.