The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

Abstract

Background/AimsThe most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl®. However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study.MethodsNinety-three patients at Soonchunhyang University Hospital with acute GVB who received GVO using Histoacryl® were enrolled between June 2001 and March 2010. Among these, 42 patients underwent GVO alone (GVO group) and 51 patients underwent GVO with adjuvant BB therapy (GVO+BB group). This study was intended for patients in whom a desired heart rate was reached. The rates of rebleeding-free survival and overall survival were calculated for the two study groups using Kaplan-Meyer analysis and Cox's proportional-hazards model.ResultsThe follow-up period after the initial eradication of gastric varices was 18.14±25.22 months (mean±SD). During the follow-up period, rebleeding occurred in 10 (23.8%) and 21 (41.2%) GVO and GVO+BB patients, respectively, and 39 patients died [23 (54.8%) in the GVO group and 16 (31.4%) in the GVO+BB group]. The mean rebleeding-free survival time did not differ significantly between the GVO and GVO+BB groups (65.40 and 37.40 months, respectively; P=0.774), whereas the mean overall survival time did differ (52.54 and 72.65 months, respectively; P=0.036).Conclusions Adjuvant BB therapy after GVO using Histoacryl® for the first acute episode of GVB could decrease the mortality rate relative to GVO alone. However, adjuvant BB therapy afforded no benefit for the secondary prevention of rebleeding in GV.

Management of gastric varices

“…An RCT compared repeat GO with or without NSBB in 95 patients with GOV-2 or IGV-1 bleeding; mortality and rebleeding rates did not differ between the two groups [32]. Another recent RCT observed similar findings in terms of rebleeding-free survival time, which did not differ between the two groups (GO alone 65.4 vs. GO plus NSBB 37.4 months; P = 0.77), but patients receiving NSBB had significantly better survival (52.5 vs. 72.6 months; P =0.036) [33]. In our survey, 45.6% of practitioners used NSBB combined with GO.…”

Endoscopic Cyanoacrylate Glue Injection in Management of Gastric Variceal Bleeding: US Tertiary Care Center Experience

“…Previously beta-blockers have shown a decrease in recurrence of bleeding in GV with or without ECGI. 20,27,28 Henceforth, we consider beta-blockers for primary bleeding prophylaxis in patients with large GV and for secondary prophylaxis after successful ECGI. In the presence of a gastrorenal shunt, BRTO of GV has been reported as a safe and effective treatment modality for hemostasis and has a low rebleeding rate.…”

Liver stiffness-spleen diameter to platelet ratio score (LSPS model) predicts variceal rebleeding for cirrhotic patients

“…More than 50% of patients with acute EGVB under the recommended therapy experience rebleeding in 1 year, and this is one of the most common reasons for readmission [1]. Furthermore, many fatal complications can follow EGVB, such as hepatic encephalopathy, liver failure and hemorrhagic shock [2]. Endoscopic therapy combined with nonselective β-blockers (NSBBs) is regarded as 'the standard therapy' for secondary prophylaxis of rebleeding [3].…”