231 Is prophylactic banding always safe? Randomized controlled trial for the prevention of first variceal bleeding in cirrhotic patients with contraindications or intolerance to B-blockers

Triantos, C.; Vlachogiannakos, John; Armonis, Anastasios; Saveriadis, Adamos; Kougioumtzian, A.; Leandro, Gioacchino; Manolakopoulos, Spilios; Raptis, S.; Burroughs, A.K.; Avgerinos, Alec

doi:10.1016/s0168-8278(04)90231-0

Cited by 2 publications

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“…27 In one recent study reported in abstract form endoscopic band ligation was no better than no treatment and caused some bleeding from ulcers. 85 …”

Section: Randomised Controlled Trials Of Primary Preventionmentioning

confidence: 99%

Management of portal hypertension

Samonakis

Triantos

Thalheimer

et al. 2004

Postgraduate Medical Journal

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Treatment of portal hypertension is evolving based on randomised controlled trials. In acute variceal bleeding, prophylactic antibiotics are mandatory, reducing mortality as well as preventing infections. Terlipressin or somatostatin combined with endoscopic ligation or sclerotherapy is the best strategy for control of bleeding but there is no added effect of vasoactive drugs on mortality. Non-selective β-blockers are the first choice therapy for both secondary and primary prevention; if contraindications or intolerance to β-blockers are present then band ligation should be used. Novel therapies target the increased intrahepatic resistance caused by microcirculatory intrahepatic deficiency of nitric oxide and contraction of activated intrahepatic stellate cells.

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“…27 In one recent study reported in abstract form endoscopic band ligation was no better than no treatment and caused some bleeding from ulcers. 85 …”

Section: Randomised Controlled Trials Of Primary Preventionmentioning

confidence: 99%

Management of portal hypertension

Samonakis

Triantos

Thalheimer

et al. 2004

Postgraduate Medical Journal

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Endoscopic band ligation in the treatment of portal hypertension

García‐Pagán

Bosch

2005

Nat Rev Gastroenterol Hepatol

137

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The evidence that endoscopic band ligation (EBL) has greater efficacy and fewer side effects than endoscopic injection sclerotherapy has renewed interest in endoscopic treatments for portal hypertension. The introduction of multishot band devices, which allow the placement of 5-10 bands at a time, has made the technique much easier to perform, avoiding the use of overtubes and their related complications. EBL sessions are usually repeated at 2 week intervals until varices are obliterated, which is achieved in about 90% of patients after 2-4 sessions. Variceal recurrence is frequent, with 20-75% of patients requiring repeated EBL sessions. According to current evidence, nonselective beta-blockers are the preferred treatment option for prevention of a first variceal bleed, whereas EBL should be reserved for patients with contraindications or intolerance to beta-blockers. Nonselective beta-blockers, probably in association with the vasodilator isosorbide mononitrate, and EBL are good treatment options to prevent recurrent variceal rebleeding. The efficacy of EBL might be increased by combining it with beta-blocker therapy. Patients who are intolerant, have contraindications or bled while receiving primary prophylaxis with beta-blockers must be treated with EBL. In the latter situation, EBL should be added to rather than replace beta-blocker therapy. EBL, in combination with vasoactive drugs, is the recommended form of therapy for acute esophageal variceal bleeding; however, endoscopic injection sclerotherapy can be used in the acute setting if EBL is technically difficult.

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231 Is prophylactic banding always safe? Randomized controlled trial for the prevention of first variceal bleeding in cirrhotic patients with contraindications or intolerance to B-blockers

Cited by 2 publications

References 0 publications

Management of portal hypertension

Management of portal hypertension

Endoscopic band ligation in the treatment of portal hypertension

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