Abstract
Esophageal varices are a commonly encountered complication of cirrhosis. ß-blockers are a well-established cornerstone of the treatment of portal hypertension and primary and secondary prophylaxis for prevention of esophageal variceal bleeding. However, not all patients tolerate this type of therapy. Moreover, the exact role of esophageal variceal band ligation alone or in combination with ß-blocker therapy in the management of patients with esophageal varices remains to be defined. This summary report presents a number of recent studies addressing these important issues.
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References and Recommended Reading
D’Amico G, Pagliaro L, Bosch J: The treatment of portal hypertension: a meta-analytic review. Hepatology 1995, 22:332–354.
Grace ND, Groszmann RJ, Garcia-Tsao G, et al.: Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology 1998, 28:868–880. An excellent review of the current state of the art in the diagnosis and management of portal hypertension.
Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, et al.: Noninvasive predictors of the presence of large esophageal varices in patients with cirrhosis. Dig Liver Dis 2003, 35:473–478.
Schepis F, Camma C, Niceforo D, et al.: Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology 2001, 33:333–338.
Madhotra R, Mulcahy HE, Willner I, et al.: Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol 2002, 34:81–85.
Zaman A, Hapke R, Flora K, et al.: Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol 1999, 94:3292–3296.
Zaman A, Becker T, Lapidus J, et al.: Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 2001, 161:2564–2570.
Burton JR Jr, Lapidus J, Zaman A: A multivariate model predicts presence and size of varices: a validation study [abstract]. Gastroenterology 2003, 124(Suppl):S1541A.
Andreani T, Poupon RE, Balkau BJ, et al.: Preventive therapy of first gastrointestinal bleeding in patients with cirrhosis: results of a controlled trial comparing propranolol, endoscopic sclerotherapy and placebo. Hepatology 1990, 12:1413–1419.
Groszmann RJ, Garcia-Tsao G, Makuch R, et al.: Multicenter randomized placebo-controlled trial of non-selective betablockers in the prevention of the complications of portal hypertension: final results and identification of a predictive factor [abstract]. Hepatology 2003, 8(Suppl 1):103A. A well-designed trial that addresses the question of whether ß-blocker therapy prevents the development of esophageal varices.
Merkel C, Marin R, Angeli P, et al.: Beta-blockers in the prevention of aggravation of esophageal varices in patients with cirrhosis and small varices: a placebo-controlled clinical trial [abstract]. Hepatology 2003, 8(Suppl 1):127A. Addresses the important question of whether patients with small esophageal varices should be placed on ß-blocker therapy to prevent their progression to large varices.
Schepke M, Goebel C, Nuernberg D, et al.: Endoscopic banding ligation versus propranolol for the primary prevention of variceal bleeding in cirrhosis: a randomized controlled multicenter trial [abstract]. Hepatology 2003, 8(Suppl 1):128A.
Lui HF, Stanley AJ, Forrest EH, et al.: Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate. Gastroenterology 2002, 123:735–744.
Kiafar C, Gerkin RD, Ramirez F, et al.: Variceal eradication is not associated with better outcomes than non-eradication [abstract]. Gastroenterology 2003, 124(Suppl):S1533A.
Villanueva C, Minana J, Ortiz J, et al.: Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med 2001, 345:647–655.
Lo GH, Chen WC, Chen MH, et al.: Banding ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding. Gastroenterology 2002, 123:728–734.
Lo GH, Lai KH, Cheng JS, et al.: Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology 2000, 32:461–465.
De La Pena J, Rivero M, Garcia-Suarez C, et al.: Variceal ligation plus nadolol compared with variceal ligation after bleeding: multicenter randomized trial preliminary analysis [abstract]. Gastroenterology 2003, 124(Suppl):S1538A.
Tseng CC, Green RM, Burke SK, et al.: Bacteremia after endoscopic band ligation of esophageal varices. Gastrointest Endosc 1992, 8:336–337.
Lo GH, Lai KH, Shen MT, et al.: A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices. Gastrointest Endosc 1994, 40:675–679.
da Silveira Rohr MR, Siqueira ES, Brant CQ, et al.: Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis. Gastrointest Endosc 1997, 46:321–323.
Nagamine N, Ono K, Ido K, et al.: A prospective study of the risk of bacteremia in endoscopic band ligation of esophageal varices [abstract]. Gastrointest Endosc 2003, 57:M1780A.
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Gawrieh, S., Saeian, K. Management of esophageal varices: An update from Digestive Disease Week and American Association for the Study of Liver Diseases 2003. Curr Gastroenterol Rep 6, 206–209 (2004). https://doi.org/10.1007/s11894-004-0008-3
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DOI: https://doi.org/10.1007/s11894-004-0008-3