Primary prophylaxis of variceal bleeding in cirrhotic patients

A cohort study

A. Dell'Era, J. Cubero Sotela, F. M. Fabris, G. Petazzi, R. Reati, F. Iannuzzi, A. Nicolini, M. G. Rumi, R. de Franchis, M. Primignani

Research output: Contribution to journalArticle

16 Citations (Scopus)

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 languageEnglish
Pages (from-to)936-943
Number of pages8
JournalDigestive and Liver Disease
Volume40
Issue number12
DOIs
Publication statusPublished - Dec 2008

Fingerprint

Cohort Studies
Hemorrhage
Ligation
Hepatic Veins
Hemodynamics
Pressure
Esophageal and Gastric Varices
Primary Prevention
Guidelines
Mortality

Keywords

  • Beta-blockers
  • Endoscopic band ligation
  • Hepatic vein pressure gradient
  • Oesophageal varices

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Dell'Era, A., Cubero Sotela, J., Fabris, F. M., Petazzi, G., Reati, R., Iannuzzi, F., ... Primignani, M. (2008). Primary prophylaxis of variceal bleeding in cirrhotic patients: A cohort study. Digestive and Liver Disease, 40(12), 936-943. https://doi.org/10.1016/j.dld.2008.03.017

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 journalArticle

Dell'Era, A, Cubero Sotela, J, Fabris, FM, Petazzi, G, Reati, R, Iannuzzi, F, Nicolini, A, Rumi, MG, de Franchis, R & Primignani, M 2008, 'Primary prophylaxis of variceal bleeding in cirrhotic patients: A cohort study', Digestive and Liver Disease, vol. 40, no. 12, pp. 936-943. https://doi.org/10.1016/j.dld.2008.03.017
Dell'Era A, Cubero Sotela J, Fabris FM, Petazzi G, Reati R, Iannuzzi F et al. Primary prophylaxis of variceal bleeding in cirrhotic patients: A cohort study. Digestive and Liver Disease. 2008 Dec;40(12):936-943. https://doi.org/10.1016/j.dld.2008.03.017
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. / Primary prophylaxis of variceal bleeding in cirrhotic patients : A cohort study. In: Digestive and Liver Disease. 2008 ; Vol. 40, No. 12. pp. 936-943.
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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.",
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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

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