Objectives Data in the literature regarding the role of endoscopic
variceal ligation for the prevention of first variceal bleeding in
cirrhotic patients are controversial. To further explore this issue we
have compared ligation and propranolol treatment in a prospective
randomized study.
Methods Sixty patients with cirrhosis and oesophageal varices with no
history but at high risk of bleeding were randomized to ligation
treatment (30 patients) or propranolol (30 patients). Patients were
followed for approximately 27.5 months.
Results Variceal obliteration was achieved in 28 patients (93.3%) after
3 +/- 1 sessions. The mean daily dose of propranolol was 60.3 +/- 13.3
mg. Two patients (6.7%) in the ligation group and nine patients (30%)
in the propranolol group developed variceal bleeding (P=0.043). The
actuarial risks of variceal bleeding at 2 years were 6.7% and 25%,
respectively. On multivariate analysis, propranolol treatment and grade
III varices turned out to be predictive factors for the risk of variceal
bleeding. Mortality was not different between the two groups. There were
no serious complications due to ligation. Propranolol treatment was
discontinued in four patients because of side effects.
Conclusions Variceal ligation is a safe and more effective method than
propranolol treatment for the prevention of first variceal bleeding in
cirrhotic patients with high-risk varices
