Abstract
Background: Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However, it has been suggested that these patients may respond poorly to band ligation. Aim: We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers. Methods: One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group B) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers. Results: Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A, 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%). Conclusions: Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers.
| Original language | English |
|---|---|
| Pages (from-to) | 936-943 |
| Number of pages | 8 |
| Journal | Digestive and Liver Disease |
| Volume | 40 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - Dec 2008 |
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Keywords
- Beta-blockers
- Endoscopic band ligation
- Hepatic vein pressure gradient
- Oesophageal varices
ASJC Scopus subject areas
- Gastroenterology
- Hepatology
Cite this
Primary prophylaxis of variceal bleeding in cirrhotic patients : A cohort study. / Dell'Era, A.; Cubero Sotela, J.; Fabris, F. M.; Petazzi, G.; Reati, R.; Iannuzzi, F.; Nicolini, A.; Rumi, M. G.; de Franchis, R.; Primignani, M.
In: Digestive and Liver Disease, Vol. 40, No. 12, 12.2008, p. 936-943.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Primary prophylaxis of variceal bleeding in cirrhotic patients
T2 - A cohort study
AU - Dell'Era, A.
AU - Cubero Sotela, J.
AU - Fabris, F. M.
AU - Petazzi, G.
AU - Reati, R.
AU - Iannuzzi, F.
AU - Nicolini, A.
AU - Rumi, M. G.
AU - de Franchis, R.
AU - Primignani, M.
PY - 2008/12
Y1 - 2008/12
N2 - Background: Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However, it has been suggested that these patients may respond poorly to band ligation. Aim: We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers. Methods: One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group B) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers. Results: Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A, 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%). Conclusions: Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers.
AB - Background: Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However, it has been suggested that these patients may respond poorly to band ligation. Aim: We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers. Methods: One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group B) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers. Results: Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A, 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%). Conclusions: Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers.
KW - Beta-blockers
KW - Endoscopic band ligation
KW - Hepatic vein pressure gradient
KW - Oesophageal varices
UR - http://www.scopus.com/inward/record.url?scp=55549094433&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=55549094433&partnerID=8YFLogxK
U2 - 10.1016/j.dld.2008.03.017
DO - 10.1016/j.dld.2008.03.017
M3 - Article
VL - 40
SP - 936
EP - 943
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 12
ER -