Ligation VS propranolol for primary prophilaxis of variceal bleeding using a multiple band liga-tor and objective measurements of treatment adequacy: Preliminary results

Mora, Jose G. De la; Farca-Belsaguy, A; Uribe, Misael; Hoyos-Garza, Andres de

doi:10.1016/s0016-5085(00)81633-9

Cited by 25 publications

(13 citation statements)

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“…122 Sixteen trials have compared EBL with b-adrenergic blockers as a first-line option for primary prophylaxis of variceal bleeding. [123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138] The meta-analysis of these trials shows an advantage of EBL over b-adrenergic blockers in terms of prevention of first bleeding, without differences in mortality (Fig. 5).…”

Section: Patients With Varicesmentioning

confidence: 98%

Portal Hypertension and Gastrointestinal Bleeding

et al. 2008

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Variceal bleeding is one of the most serious complications of portal hypertension. The driving force for the development of varices is an increase in portal pressure. As portal hypertension progresses, varices dilate until they finally rupture and bleed. This sequence of events might be prevented by achieving a sufficient decrease in portal pressure or by acting locally at the varices with endoscopic treatments. This article reviews the rationale for the management of portal hypertension and the current recommendations for the prevention and treatment of variceal bleeding.

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Section: Patients With Varicesmentioning

confidence: 98%

Portal Hypertension and Gastrointestinal Bleeding

et al. 2008

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“…15 Sixteen trials have compared EBL with b-blockers as a first-line option for primary prophylaxis of variceal bleeding. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A meta-analysis of these trials showed an advantage of EBL over b-blockers in terms of prevention of first bleeding, without differences in mortality, although 6 of these trials are available only in abstract form. When the meta-analysis is restricted to published studies, there is no significant benefit from EBL compared to b-blockers.…”

Section: Prevention Of the First Bleeding Episodementioning

confidence: 99%

Care of the Cirrhotic Patient

Grewal

Martin

2009

Clinics in Liver Disease

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“…1). [36][37][38][39][40][41][42][43][44][45][46][47][48][49] The studies are relatively uniform regarding the size of varices, which ranged from medium to large in all, and doses of BB. However, they differed markedly in terms of other variables such as sample size (range, 24 to 152 patients), length of follow-up (range, 11 to 55 mo, more than 2 y in only 2 of the studies), and proportion of patients with advanced (Child C class) liver disease (range, 13% to 33%) and with alcoholic cirrhosis (range, 10% to 70%).…”

Section: Endoscopic Treatment: Variceal Band Ligationmentioning

confidence: 99%

“…VBL emerged as significantly better than BB in 4 of the trials, 38,42,46,48 whereas no differences between treatments were detected in the other 10 trials. 36,37,[39][40][41][43][44][45]47 A slight difference in mortality in favor of VBL was observed in 1 trial. 46 Meta-analysis of these trials in both therapeutic arms (odds ratio, 1.02; 95% CI, 0.74-1.41).…”

Section: Endoscopic Treatment: Variceal Band Ligationmentioning

confidence: 99%

Preventing First Variceal Hemorrhage in Cirrhosis

Albillos

2007

Journal of Clinical Gastroenterology

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Variceal bleeding is still a life-threatening complication of portal hypertension responsible for an appreciable rate of morbidity and mortality. The most appropriate treatment approach, whether drugs (nonselective beta-blockers) or endoscopic (variceal band ligation) therapy, to prevent the initial bleed, or primary prophylaxis, is an issue of controversy. Meta-analysis of randomized controlled trials indicates that banding seems to be somehow slightly more effective than beta-blockers at preventing a first bleeding episode, but this does not translate to improved survival. The firmness of this conclusion is, in addition, diminished by the small sample size and short follow-up of most studies. Moreover, adverse events due to banding are more severe than those associated with beta-blockers. Thus, beta-blockers remain as first-line therapy in patients with cirrhosis and large esophageal varices. Prophylactic therapy with beta-blockers can be considered in patients with small varices, especially in those with red signs or Child class C liver disease. The available evidence does not support the idea that organic nitrates improve the efficacy of beta-blockers in primary prophylaxis. The method used to establish the dose of beta-blockers and check its effect on hepatic venous pressure gradient (HVPG) has also been disputed. An attractive strategy is to measure the HVPG response to beta-blockers as a guide to primary prophylaxis, with the aim of switching to another therapy, that is, band ligation, in HVPG nonresponders. However, no study has yet demonstrated that banding as rescue therapy in nonresponders lowers the risk of first bleeding and improves survival.

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Ligation VS propranolol for primary prophilaxis of variceal bleeding using a multiple band liga-tor and objective measurements of treatment adequacy: Preliminary results

Cited by 25 publications

References 0 publications

Portal Hypertension and Gastrointestinal Bleeding

Portal Hypertension and Gastrointestinal Bleeding

Care of the Cirrhotic Patient

Preventing First Variceal Hemorrhage in Cirrhosis

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