Optimum Therapy for Secondary Prophylaxis of Variceal Bleeding Patient: Endoscopic, Pharmacological or Combination, A Randomized Study

Abstract

Aims and Objective:  To compare pharmacological therapy alone, endoscopic band ligation every 2 weeks, band ligation every 4 weeks and combination of drugs and band ligation 2 weekly for prevention of rebleeding in patients being admitted with haematemesis and malena due to esophageal varices.

Patients and Methods:  All patients being admitted with upper GI bleeding due to cirrhosis of liver were included in study after being stabilized with in hospital treatment and endoscopic band ligation. Patients were randomized in four groups, i.e. propranolol alone, endoscopic band ligation every 2 week till obliteration of varices, band ligation every 4 weeks and combination of beta blocker and band ligation every 2 weeks for secondary prophylaxis of GI bleed. Patients were followed monthly there after for rebleeding or other complications for six months.

Results:  Total of 62 patients were included with male/female ratio 2.64/1 (45/17). Hepatitis C was the etiology of cirrhosis in 55 (88.7%) of them. Ascites was present in 25 (40.4%) patients while 7 (11.3%) had hepatic encephalopathy. On endo-scopy high grade esophageal varices were noted in 51 (82.3%) of them and 13 (21%) also had fundal vrices. Band ligation was done in all patients. Patients were randomized in four groups and numbers in groups were 14/13/15/18 respectively. After 6 months follow up 7 patients were lost to follow up. Rebleeding was noted in 5 (8.6%) patients at 3 months, and in 7 (12.7%) after 6 months. Total of 11 (18.6%) patients died after 3 months while 13 (23.6%) were not alive after 6 months but only one due to rebleeding. Significantly more rebleeding was noted in group 1, on propranolol only while no difference in other 3 groups was noted.

Conclusion:  Endoscopic band ligation has shown better results for control of rebleeding in patients with variceal bleeding as compared to pharmacological treatment alone.

Key Words:  Band ligation, Cirrhosis, Esophageal varices, Secondary prophylaxis.