Efficacy of Oral Propranolol and Injection Sclerotherapy in the Long-Term Management of Variceal Bleeding

Abstract

Three treatment regimens were tried in 145 portal hypertensives with bleeding oesophageal varices to test the efficacy of each regimen in the prevention of rebleeding. Forty-seven cases received oral propranolol, 57 sclerotherapy, while 41 who did not receive any treatment except conservative management served as controls. Patients were followed up at 6 weeks, 6 months, 1 and 2 years to see the frequency of bleeding with each regimen. No significant difference was seen at 6 weeks with either of the three regimens but at 6 months and 1 year the frequency of bleeding was significantly less (p < 0.05) in the propranolol group than in the other two groups while at 2 years results were significantly better with both propranolol (p < 0.05) and sclerotherpay (p < 0.001) than in controls. Efficacy of propranolol when compared with sclerotherapy showed similar results. The results of the present study are different from most of the western reports where sclerotherapy was found to be superior to propranolol. Variations in the results are likely to be due to differences in the etiology of portal hypertension in different countries.

Long‐term management of variceal bleeding: The place of pharmacotherapy

“…In the trial where propranolol was used to prevent recurrent gastrointestinal bleeding from portal hypertensive gastropathy, the percentage of patients who rebled was significantly lower in the propranolol group than in the control group. In the two trials performed in patients with noncirrhotic portal hypertension, the risk of rebleeding was significantly lower in patients receiving t-blockers for 1 or 2 years than in patients receiving a placebo [27,28]. No significant difference was found in the survival rate.…”

“…Among 14 trials comparing/3-adrenergic antagonists and placebo for the prevention of recurrent gastrointestinal bleeding, 12 were performed in patients with cirrhosis [2, 16--26] and 2 in patients with idiopathic portal hypertension or schistosomiasis [27,28]. The follow-up was I or 2 years.…”

“…Ten studies compared the etticacity of/3-blockers and endoscopic sclerotherapy for the prevention of recurrent gastrointestinal bleeding in patients with cirrhosis [23,28,[31][32][33][34][35][36][37][38]. Seven studies found no significant difference between the two groups; one study found that the risk of rebleeding was lower in patients receiving /3-blockers than in patients treated with endoscopic sclerotherapy [32]; and two studies found that patients treated by sclerotherapy had a significantly lower incidence of rebleeding than did patients receiving/3-blockers [31,37].…”

Does elective sclerotherapy improve the efficacy of long-term propranolol for prevention of recurrent bleeding in patients with severe cirrhosis? A prospective multicenter, randomized trial

“…In many studies on the secondary prevention of gastroesophageal bleeding in cirrhosis, P-blockade and sclerotherapy have been shown to have equivalent results on recurrent bleeding or overall mortality (1)(2)(3)(4)(5)(6)(7)(8). Some recent trials have suggested that propranolol can reduce recurrent gastroesophageal bleeding in cirrhotic patients treated with elective sclerotherapy (9)(10)(11)(12).…”

“…Third, p-blockade significantly reduces the occurrence of recurrent gastroesophageal bleeding, death from recurrent bleeding and overall mortality (28) but is less effective in Child class C patients (17,19); however, propranolol has the advantage of being safe and costeffective. Fourth, sclerotherapy significantly reduces the risk of recurrent variceal bleeding and of mortality, and most comparative trials have shown both treatments to have nonsignificantly hfferent results (1)(2)(3)(4)(5)(6)(7)(8)36). However, one study suggested that apart from emergency treatment for bleeding, elective sclerotherapy had no effect on the prevention of recurrent variceal bleeding (37).…”