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Endoscopic ultrasonography assessment of para-esophageal varices predicts efficacy of propranolol in preventing recurrence of esophageal varices

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Volume of para-esophageal varices (PEV) correlates with esophageal varices recurrence. The effect of propranolol on volumetric change of PEV has not been studied. The relation between EV recurrence and volumetric change of PEV in patients undergoing endoscopic variceal ligation (EVL) with and without propranolol are studied.

Methods

Sixty-six patients who achieved EV eradication by primary EVL were randomly allocated to a propranolol group (n = 33) or control group (n = 33). The endpoints of the study were EV recurrence and volumetric change of PEV assessed by using endoscopic ultrasonography (EUS) at 3-month intervals for 2 years.

Results

The cumulative probability of recurrence at two years was 28 % in the propranolol group (n = 9) and 68 % in the control group (n = 20) (p = 0.005, log-rank test). Difference of the volumetric change of PEV became significant as early as at the third month [−0.12 (−0.38–0.34) vs. 0.14 (−0.06–0.57), p < 0.001] between the two groups. Regression of PEV was achieved in 20 patients of the propranolol group at a median time of three months (range 3–12 months), and no EV recurrence was found at the end of follow-up for two years. On multivariate analysis, the volumetric change of PEV at the third month and use of propranolol were determinants of EV recurrence.

Conclusions

Propranolol may reduce both EV recurrence rate and volume of PEV in patients achieving endoscopic eradication. Regression of PEV is a predictor of durable eradication of EV without recurrence in patients using propranolol. EUS is an objective and useful tool to measure PEV and predict recurrence of EV.

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Acknowledgments

This work was supported in part by grants V97C1-023 and V98C1-034 from the Veterans General Hospital-Taipei, and in part by a grant NSC99-2314-B-010-MY3 from the National Science Council, Taiwan.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. School of Medicine, National Yang Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan (ROC)

    Wei-Chih Liao, Ping-Hsien Chen, Ming-Chih Hou, Chen-Jung Chang, Chien-Wei Su, Han-Chieh Lin & Fa-Yauh Lee

  2. Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan

    Wei-Chih Liao

  3. Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan

    Ping-Hsien Chen & Ming-Chih Hou

  4. Division of Gastroenterology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Ming-Chih Hou, Chien-Wei Su, Han-Chieh Lin & Fa-Yauh Lee

  5. Taipei Medical University Hospital, Taipei, Taiwan

    Chen-Jung Chang

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  1. Wei-Chih Liao
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Correspondence to Ming-Chih Hou.

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Liao, WC., Chen, PH., Hou, MC. et al. Endoscopic ultrasonography assessment of para-esophageal varices predicts efficacy of propranolol in preventing recurrence of esophageal varices. J Gastroenterol 50, 342–349 (2015). https://doi.org/10.1007/s00535-014-0970-y

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  • DOI: https://doi.org/10.1007/s00535-014-0970-y

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