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A Randomized Controlled Trial of Propranolol Use During Ligation Program for Secondary Prophylaxis of Esophageal Variceal Bleeding.
Chen, Wen-Chi; Yang, Tsung-Chieh; Lee, Pei-Chang; Wang, Yen-Po; Hou, Ming-Chih; Lee, Fa-Yauh.
Afiliación
  • Chen WC; Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
  • Yang TC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
  • Lee PC; Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
  • Wang YP; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
  • Hou MC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Lee FY; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Am J Gastroenterol ; 119(2): 278-286, 2024 Feb 01.
Article en En | MEDLINE | ID: mdl-37543755
ABSTRACT

INTRODUCTION:

Endoscopic variceal ligation (EVL) plus nonselective ß-blockers (NSBB) is the standard of care for secondary prophylaxis of esophageal variceal bleeding (EVB). This trial aimed to compare the rebleeding rates between EVL plus NSBB till eradication of esophageal varices (EEV) and EVL plus long-term NSBB.

METHODS:

After control of acute EVB, patients with cirrhosis were randomized into 2 groups, with group A patients receiving EVL plus propranolol till EEV, while group B patients received standard of care with continuation of propranolol. Recurrent varices were ligated at follow-up endoscopy in both groups.

RESULTS:

The median follow-up period was 23.0 months in group A (n = 106) and 23.6 months in group B (n = 106). Twelve patients (11.3%) in group A and 11 (10.4%) in group B had recurrent EVB. The difference in rebleeding rates and the 95% confidence interval (CI) was 0.9% (-7.5% to 9.3%). The upper 95% CI bound of the difference was within the margin of 13.2%, and the noninferiority of group A to group B was established. Thirty-eight patients (35.8%) in group A and 40 (37.7%) in group B had further decompensation, with the difference (95% CI) of -1.9% (-14.9% to 11.1%). Twenty-four patients (22.6%) in group A and 26 (24.5%) in group B expired, with the difference (95% CI) in mortality rates of -1.9% (-13.3% to 9.5%).

DISCUSSION:

EVL plus propranolol till EEV was noninferior to EVL plus continuing propranolol in secondary prophylaxis of EVB, but the impact on further decompensation and transplantation-free survival deserved further investigation.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Propranolol / Várices Esofágicas y Gástricas Tipo de estudio: Clinical_trials Límite: Humans Idioma: En Revista: Am J Gastroenterol Año: 2024 Tipo del documento: Article País de afiliación: Taiwán

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Propranolol / Várices Esofágicas y Gástricas Tipo de estudio: Clinical_trials Límite: Humans Idioma: En Revista: Am J Gastroenterol Año: 2024 Tipo del documento: Article País de afiliación: Taiwán