Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding

Abstract

Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.

Carvedilol for prevention of variceal bleeding: a systematic review and meta analysis

“…Subsequently, the remaining 39 records were assessed at full text level. Twenty-two records describing 13 [20][21][22][23][24][25][26][27][28][29][30][31][32] trials (1598 patients) were finally included in the meta-analysis.…”

“…Eight trials were published as full-text manuscripts, whereas the remaining 5 trials were available only in abstract form. Six trials assessed carvedilol for primary prophylaxis of variceal bleeding compared with endoscopic variceal ligation (EVL) [22][23][24][25] or propranolol [20][21][22]. Secondary prophylaxis was evaluated in 6 trials comparing carvedilol with EVL [27,28,32], propranolol [29] or NSBBs plus isosorbide-5-mononitrate (ISMN) [27,31].…”

“…Most patients had F2 EV with viral related cirrhosis, and had Class B disease according to the Child -Pugh classification. Concomitant gastric varices were present in 98 patients in total (5 trials [22,[24][25][26]31]).…”

Primary prophylaxis of variceal bleeding

“…In this journal, Abd ElRahim et al [8]. compared carvedilol, propranolol and EVL for primary prophylaxis of AVB in 264 patients with cirrhosis and high-risk varices.…”

“…Current expert consensus is that NSBBs or EVL have largely equivalent efficacy in preventing AVB; the choice of treatment should be based on individual patient characteristics, local resources and expertise and patient preference [6,7]. Primary prophylaxis is addressed in this journal in the paper by Abd ElRahim et al [8].…”