Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis

Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding

“…Compared with previous trials, our current figures of variceal bleed and upper gastrointestinal bleed in both groups were reasonable. [9][10][11][12] A total of 321 patients (70%) were excluded from the study. The majority of these excluded patients were due to the presence of hepatocellular carcinoma and old age.…”

“…Serious complications were noted only in two patients (3%) of the Combined group with esophageal ulcer bleed and variceal bleed directly induced by EVL, similar to our previous trials. 10,29 This implies that the potential benefit of EVL in prevention of variceal rupture is offset by the associated serious complications. Previous meta-analysis of trials regarding primary prophylaxis revealed that adverse events were associated with EVL in 42.7% and with beta blockers in 56.1%.…”

“…8 Controlled studies that compared EVL with a beta blocker in the prevention of first variceal bleeding showed that EVL was at least equivalent to beta blockers in the prophylaxis of first variceal bleeding. [9][10][11][12] The strength of EVL lies in its ability to obliterate varices. However, the portal pressure may be elevated after repeated EVL.…”

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

“…Studies of VBL for primary prophylaxis that include patients with high-risk esophageal varices have shown that VBL significantly reduces the risk of first variceal bleeding and that serious adverse effects are uncommon [53][54][55][56][57]. A meta-analysis of five studies of VBL versus placebo suggested that VBL reduces the risk of first variceal bleed, bleeding-related mortality, and overall mortality [58].…”

“…Various published randomized trials comparing the efficacy and safety of VBL and b-blockers in primary prophylaxis exist [53][54][55][56][57][63][64][65][66][67]. A recent meta-analysis suggests that VBL has greater efficacy in preventing initial bleeding with a 34% relative risk reduction than do b-blockers.…”