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J Hepatol. 2014 Nov;61(5):1014-9. doi: 10.1016/j.jhep.2014.06.015. Epub 2014 Jun 19.

Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding.

Author information

1
Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK. Electronic address: Adrian.stanley@ggc.scot.nhs.uk.
2
Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK.
3
Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
4
Gastroenterology Unit, Gartnavel General Hospital, Glasgow, UK.
5
Gastroenterology Unit, Southern General Hospital, Glasgow, UK.
6
Department of Statistics, Strathclyde University, Glasgow, UK.

Abstract

BACKGROUND & AIMS:

Rebleeding after an initial oesophageal variceal haemorrhage remains a significant problem despite therapy with band ligation, non-selective β-blockers or a combination of these. Carvedilol is a vasodilating non-selective β-blocker with alpha-1 receptor and calcium channel antagonism. A recent study has suggested it is effective in the prevention of a first variceal bleed. Our aim was to compare oral carvedilol with variceal band ligation (VBL) in the prevention of rebleeding following a first variceal bleed.

METHODS:

Patients who were stable 5 days after presentation with a first oesophageal variceal haemorrhage and had not been taking β-blockers were randomised to oral carvedilol or VBL. Patients were followed-up after one week, monthly, then every 3 months. The primary end point was variceal rebleeding on intention-to-treat analysis.

RESULTS:

64 patients were randomised, 33 to carvedilol and 31 to VBL. 58 (90.6%) patients had alcohol related liver disease. Age and Child-Pugh score were similar in both groups at baseline. Median follow-up was 26.3 (interquartile range [IQR] 10.2-46.6)months. Compliance was 68% and 65% for carvedilol and VBL respectively (p=0.993) and serious adverse events between the two groups were similar (p=0.968). Variceal rebleeding occurred during follow-up in 12 (36.4%) and 11 (35.5%) patients in the carvedilol and VBL groups, respectively (p=0.857), with 9 (27.3%) and 16 (51.6%) deaths in each group, respectively (p=0.110).

CONCLUSIONS:

Carvedilol is not superior to VBL in the prevention of variceal rebleeding. The trend to a survival benefit for patients taking this drug compared with those undergoing banding requires further exploration.

KEYWORDS:

Band ligation; Carvedilol; Portal hypertension; Variceal haemorrhage

PMID:
24953021
DOI:
10.1016/j.jhep.2014.06.015
[Indexed for MEDLINE]

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