Propranolol or propranolol combined endoscopic treatments for secondary prophylaxis of esophageal variceal bleeding：a comparison study

Abstract

Objective To evaluate the prophylactic effects of proprauolol, propranolol plus endo-scopic variceal ligation （EVL） and propranolol plus endoscopic sclerotherapy （EVS） , and to determine the most effective combination for secondary prevention of esophageal variceal bleeding. Methods After hemostasis, a total of 78 patients with esophageal variceal bleeding were randomly assigned to receive propranolol （propranolol group ）, propranolol plus EVL （ligation group ） or propranolol plus sclerotherapy （EVS group） , with 26 in each group. All patients were followed up for 12 months, and the rates of variceal rebleeding, mortality, portal hypertensive gastropathy （PHG）, re-occurrence of esophageal varices and forma- tion of gastric fundus varices were compared among different groups. Results During the 12-month follow- up, the rate of re-bleeding in EVL group （ 30. 77% ） was significantly lower than those of the EVS group （42. 31% ） or propranolol group （53.85%） （P 〈0. 05）. The occurrence of PHG and fundal varices in patients of EVL group was similar to that of propranolol group, which were both lower than that of EVS group （ P 〈 0. 05 ） , but the re-occurrence of esophageal variees in EVL group was significantly higher than that of EVS group （ P 〈 O. 05 ）. Conclusion EVL plus propranolol might be the most effective therapy for secondary prophylaxis of esophageal variceal bleeding. Key words: Esophageal and gastric varices; Propranolol; Endoscopic variceal ligation; Endo- scopic variceal sclerotherapy; Secondary prophylaxis