BACKGROUND & AIMS: Patients who have had one variceal bleed are at high risk of rebleeding. Since its introduction, endoscopic variceal banding has been shown to be superior to needle sclerotherapy. Banding has not been compared with hepatic venous pressure-guided medical therapy (beta-blockers and nitrates). METHODS: One hundred two patients with cirrhosis and a recent esophageal variceal bleed were randomized to either endoscopic banding (51 patients) or medical therapy (51 patients). The hepatic venous pressure gradient was measured in all patients at baseline, at 3 months (drug therapy arm), and at yearly intervals (all patients). Primary end points were death or rebleeding. RESULTS: The 2 groups were well matched. Fifty-one percent were Pughs C, with a median Pughs score of 9.5. Nineteen patients rebled in the drug arm (median time, 24 days) and 27 patients in the banding arm (median time, 24 days). At 1 year, 43.7% of patients had bled in the drug arm compared with 53.8% in the banding arm (P = 0.25). Thirty-two percent of patients on medical therapy had died at 1 year, 22.5% on banding (P = 0.97). CONCLUSIONS: In the prevention of variceal rebleeding, beta-blockers +/- nitrates are as effective as endoscopic banding.

A RANDOMIZED CONTROLLED TRIAL OF MEDICAL THERAPY VERSUS ENDOSCOPIC LIGATION FOR THE PREVENTION OF VARICEAL REBLEEDING IN PATIENTS WITH CIRRHOSIS / Patch, D.; Sabin, A.; Goulis, J.; Gerunda, Giorgio Enrico; Greenslade, L; Merkel, C; Burroughs, Ak. - In: GASTROENTEROLOGY. - ISSN 0016-5085. - STAMPA. - 123(2002), pp. 1013-1019.

A RANDOMIZED CONTROLLED TRIAL OF MEDICAL THERAPY VERSUS ENDOSCOPIC LIGATION FOR THE PREVENTION OF VARICEAL REBLEEDING IN PATIENTS WITH CIRRHOSIS

GERUNDA, Giorgio Enrico;
2002

Abstract

BACKGROUND & AIMS: Patients who have had one variceal bleed are at high risk of rebleeding. Since its introduction, endoscopic variceal banding has been shown to be superior to needle sclerotherapy. Banding has not been compared with hepatic venous pressure-guided medical therapy (beta-blockers and nitrates). METHODS: One hundred two patients with cirrhosis and a recent esophageal variceal bleed were randomized to either endoscopic banding (51 patients) or medical therapy (51 patients). The hepatic venous pressure gradient was measured in all patients at baseline, at 3 months (drug therapy arm), and at yearly intervals (all patients). Primary end points were death or rebleeding. RESULTS: The 2 groups were well matched. Fifty-one percent were Pughs C, with a median Pughs score of 9.5. Nineteen patients rebled in the drug arm (median time, 24 days) and 27 patients in the banding arm (median time, 24 days). At 1 year, 43.7% of patients had bled in the drug arm compared with 53.8% in the banding arm (P = 0.25). Thirty-two percent of patients on medical therapy had died at 1 year, 22.5% on banding (P = 0.97). CONCLUSIONS: In the prevention of variceal rebleeding, beta-blockers +/- nitrates are as effective as endoscopic banding.
123
1013
1019
A RANDOMIZED CONTROLLED TRIAL OF MEDICAL THERAPY VERSUS ENDOSCOPIC LIGATION FOR THE PREVENTION OF VARICEAL REBLEEDING IN PATIENTS WITH CIRRHOSIS / Patch, D.; Sabin, A.; Goulis, J.; Gerunda, Giorgio Enrico; Greenslade, L; Merkel, C; Burroughs, Ak. - In: GASTROENTEROLOGY. - ISSN 0016-5085. - STAMPA. - 123(2002), pp. 1013-1019.
Patch, D.; Sabin, A.; Goulis, J.; Gerunda, Giorgio Enrico; Greenslade, L; Merkel, C; Burroughs, Ak
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/453387
Citazioni
  • ???jsp.display-item.citation.pmc??? 28
  • Scopus 190
  • ???jsp.display-item.citation.isi??? 161
social impact