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Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding

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Abstract

Background and aims

Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year.

Methods

The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol.

Results

Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III.

Conclusions

Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.

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Acknowledgements

We thank the Tropical Medicine Department of Theodor Bilharz Research Institute for support of this work.

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Authors and Affiliations

  1. Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt

    Ayman Yosry Abd ElRahim, Rabab Fouad, Marwa Khairy, Aisha Elsharkawy & Waleed Fathalah

  2. Tropical Medicine Department, Theodor Bilharz Research Institute, Giza, Egypt

    Haytham Khatamish & Moataz Seyam

  3. Pharmacology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Omayma Khorshid

  4. Pathology Department, Theodor Bilharz Research Institute, Giza, Egypt

    Mona Moussa

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  1. Ayman Yosry Abd ElRahim
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  2. Rabab Fouad
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Correspondence to Waleed Fathalah.

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Nothing to disclose.

Conflict of interest

Ayman Yosry, Rabab Fouad, Marwa Khairy, Aisha Elsharkawy, Waleed Fathalah, Haytham Khatamish, Omayma Khorshid, Mona Moussa, and Moataz Seyam declare that they have no conflicts of interest.

Ethical approval

Cairo University Ethical Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Human/animal rights statement

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Abd ElRahim, A.Y., Fouad, R., Khairy, M. et al. Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding. Hepatol Int 12, 75–82 (2018). https://doi.org/10.1007/s12072-017-9835-9

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  • DOI: https://doi.org/10.1007/s12072-017-9835-9

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