Endoscopic Variceal Ligation Plus Nadolol and Sucralfate Compared With Ligation Alone for the Prevention of Variceal Rebleeding: A Prospective, Randomized Trial

Lo, Gin‐Ho; Lai, Kwok‐Hung; Cheng, Jin‐Shiung; Chen, Mei-Hsiu; Huang, Hui‐Chun; Hsu, Ping‐I; Lin, Chiun‐Ku

doi:10.1053/jhep.2000.16236

Cited by 253 publications

(185 citation statements)

References 37 publications

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“…Two randomized trials demonstrate the superiority of combined therapy versus EVL alone. 123,124 Rebleeding rates in these 2 trials were 23% and 14%, respectively, for EVL plus nadolol compared to 47% and 38% for EVL alone. These results support the use of combination therapy to prevent rebleeding, even though a recent consensus conference recommended EVL or ␤-blocker ϩ nitrates as first-line therapy in treatmentnaïve patients.…”

Section: E Patients With Cirrhosis Who Have Recovered From Acute Varmentioning

confidence: 94%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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Section: E Patients With Cirrhosis Who Have Recovered From Acute Varmentioning

confidence: 94%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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“…Enhanced efficacy by use of beta blockers combined with EVL has been well established in the secondary prophylaxis of variceal bleeding. 16,25 It is still unknown whether a combination of EVL and beta blockers in the primary prophylaxis of variceal bleeding can be similarly effective.…”

Section: Discussionmentioning

confidence: 99%

“…13 Moreover, varices frequently recur after variceal obliteration achieved by EVL 14 and beta blockers were documented to be able to reduce variceal recurrence. 15,16 Hence, the combination of nadolol and EVL is a rational approach to prevent the first episode of variceal bleeding.…”

mentioning

confidence: 99%

Controlled Trial of Ligation Plus Nadolol Versus Nadolol Alone for the Prevention of First Variceal Bleeding

Chen

Wang

et al. 2010

Hepatology

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Both nadolol and ligation have proved to be effective in the prophylaxis of first variceal bleeding. This study was conducted to evaluate the effects and safety of combining nadolol with ligation. Cirrhotic patients with high-risk esophageal varices but without a bleeding history were considered for enrolment. Eligible patients were randomized to receive band ligation plus nadolol (Combined group, 70 patients) or nadolol alone (Nadolol group, 70 patients). In the Combined group multiligators were applied. Patients received regular ligation treatment at an interval of 4 weeks until variceal obliteration. Nadolol was administered at a dose to reduce 25% of the pulse rate in both the Combined group and the Nadolol group. Both groups were comparable in baseline data. In the Combined group 50 patients (71%) achieved variceal obliteration. The mean dose of nadolol was 52 ± 16 mg in the Combined group and 56 ± 19 mg in the Nadolol group. During a median follow-up of 26 months, 18 patients (26%) in the Combined group and 13 patients (18%) in the Nadolol group experienced upper gastrointestinal bleeding ( P = NS). Esophageal variceal bleeding occurred in 10 patients (14%) in the Combined group and nine patients (13%) in the Nadolol group ( P = NS). Adverse events were noted in 48 patients (68%) in the Combined group and 28 patients (40%) in the Nadolol group ( P = 0.06). Sixteen patients in each group died. Conclusion: The addition of ligation to nadolol may increase adverse events and did not enhance effectiveness in the prophylaxis of first variceal bleeding. (Hepatology 2010)

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“…A study by de la Peña et al (n = 80) [11] showed that four of the 20 rebleeding cases were due to bleeding esophageal ulcers. Similarly, a study by Lo et al (n = 122) [12] showed that seven of the 71 rebleeding episodes were due to esophageal ulcers.…”

Section: Discussionmentioning

confidence: 78%

“…There is a paucity of data on the incidence of bleeding from such ulcers. Results from secondary prophylaxis trials for esophageal variceal bleed showed that bleeding from postbanding ulcers is relatively uncommon [11,12]. A study by de la Peña et al (n = 80) [11] showed that four of the 20 rebleeding cases were due to bleeding esophageal ulcers.…”

Section: Discussionmentioning

confidence: 99%

Cerebral embolism following N-butyl-2-cyanoacrylate injection for esophageal postbanding ulcer bleed: a case report

et al. 2009

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Endoscopic Variceal Ligation Plus Nadolol and Sucralfate Compared With Ligation Alone for the Prevention of Variceal Rebleeding: A Prospective, Randomized Trial

Cited by 253 publications

References 37 publications

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Controlled Trial of Ligation Plus Nadolol Versus Nadolol Alone for the Prevention of First Variceal Bleeding

Cerebral embolism following N-butyl-2-cyanoacrylate injection for esophageal postbanding ulcer bleed: a case report

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