Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding
- 145 Downloads
Background and aims
Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year.
The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol.
Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III.
Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.
KeywordsPrimary prophylaxis Varices Band ligation Propranolol Carvedilol Portal hypertension
We thank the Tropical Medicine Department of Theodor Bilharz Research Institute for support of this work.
Compliance with ethical standards
Nothing to disclose.
Conflict of interest
Ayman Yosry, Rabab Fouad, Marwa Khairy, Aisha Elsharkawy, Waleed Fathalah, Haytham Khatamish, Omayma Khorshid, Mona Moussa, and Moataz Seyam declare that they have no conflicts of interest.
Cairo University Ethical Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Human/animal rights statement
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 5.Kuntz E, Dieter H. Hepatology: Principles and Practice: History, Morphology, Biochemistry, Diagnostics, Clinic, Therapy. 2nd ed. Berlin: Springer; 2006. p. 212Google Scholar
- 6.Bates JA. Abdominal Ultrasound. 2nd ed. Edinburgh: Churchill Livingstone; 2004. p. 97–107Google Scholar
- 7.WGO Practice Guidelines: Esophageal varices. WGO-OMGE practice guideline: treatment of esophageal varices. http://www.omgc.org/globalguidelines/guide08.html. Accessed 20 Sept 2016
- 14.Gluud LL, Krag A. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults. Cochrane Database Syst Rev 2012;15:18Google Scholar