The comparison of esophageal variceal ligation plus propranolol versus propranolol alone for the primary prophylaxis of esophageal variceal bleedi

• Published in: Clinical and molecular hepatology 2014, 20(3), , pp.283-290
• Main Authors: 제동모, 백용한, 곽금연, 최문석, 이준혁, 고광철, 백승운, 유병철
• Format: Article
• Language: English
• Subjects: 내과학
• ISSN: 2287-2728; 2287-285X
• DOI: 10.3350/cmh.2014.20.3.283

Background/Aims: To investigate the efficacy and longterm outcome of esophageal variceal ligation (EVL) pluspropranolol in comparison with propranolol alone for the primary prophylaxis of esophageal variceal bleeding. Methods: A total of 504 patients were retrospectively enrolled in this study. 330 patients were in propranolol group(Gr1) and 174 patients were in EVL plus propranolol group (Gr2). The endpoints of this study were esophageal varicealbleeding and mortality. Association analyses were performed to evaluate bleeding and mortality between Gr1 and Gr2. Results: EVL was more applied in patients with high risk, such as large-sized varices (F2 or F3) or positive red color signs. Total 38 patients had bleeds, 32 in Gr1 and 6 in Gr2. The cumulative probability of bleeding at 120 months was 13% inGr1 versus 4% in Gr2 (P=0.04). The predictive factors of variceal bleeding were red color signs (OR 2.962, P=0.007) andthe method of propranolol plus EVL (OR 0.160, P=0.000). 20 patients died in Gr1 and 12 in Gr2. Mortality rates are similarin the two groups compared, 6.7% in Gr1 and 6.9% in Gr2. The cumulative probability of mortality at 120 months was notsignificantly different in the two groups (7% in Gr1, 12% in Gr2, P=0.798). The prognostic factors for mortality were ageover 50 (OR 5.496, P=0.002), Child-Pugh class B (OR 3.979, P=0.001), and Child-Pugh class C (OR 10.861, P=0.000). Conclusions: EVL plus propranolol is more effective than propranolol alone in the prevention of the first varicealbleeding in patients with liver cirrhosis. KCI Citation Count: 2