Efficacy of non-selective 尾-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding: A randomized controlled trial

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• 作者：Hung-Hsu Hung¹ ; ² ; ³ ; Chen-Jung Chang¹ ; ² ; ⁴ ; Ming-Chih Hou¹ ; ² ; ³ ; ^{mchou@vghtpe.gov.tw} ; Wei-Chih Liao¹ ; ² ; ⁵ ; Che-Chang Chan¹ ; ² ; Hui-Chun Huang¹ ; ² ; Han-Chieh Lin¹ ; ² ; Fa-Yauh Lee¹ ; ² ; Shou-Dong Lee¹ ; ⁶ ; ⁷
• 关键词：GV ; gastric varices ; EV ; esophageal varices ; GVB ; gastric variceal bleeding ; EVB ; esophageal variceal bleeding ; TIPS ; trans-jugular intra-hepatic porto-systemic shunt ; GOV ; gastro-esophageal varices ; IGV ; isolated gastric varices ; GVO ; gastric variceal ob
• 刊名：Journal of Hepatology
• 出版年：2012
• 期刊代码：162_01688278
• 类别：med
• 出版时间：May, 2012
• 卷：56
• 期：5
• 页码：1025-1032
• 文件大小：969 K

摘要

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Background & Aims

Gastric variceal obturation (GVO) therapy is the current treatment of choice for gastric variceal bleeding (GVB). However, the efficacy of non-selective 尾-blockers (NSBB) in the secondary prevention of GVB is still debatable. This study aimed at evaluating the efficacy of additional NSBB to repeated GVO in the secondary prevention of GVB.

Methods

From April 2007 to March 2011, 95 patients with GVB after primary hemostasis using GVO were enrolled. Repeated GVO were performed until GV eradication. Forty-eight and 47 patients were randomized into the GVO alone group (Group A) and the GVO + NSBB group (Group B), respectively. Primary outcomes in terms of re-bleeding and overall survival were analyzed by multivariate analysis.

Results

After a mean follow-up of 18.10 months in group A, 26 patients bled and 20 died. In group B, 22 patients bled and 22 died after a mean follow-up of 20.29 months. The overall re-bleeding and survival rates analyzed by the Kaplan-Meier method were not different between the two groups (p = 0.336 and 0.936, respectively). The model of end-stage liver disease (MELD) score and main portal vein thrombosis (MPT) were independent determinants of re-bleeding while MPT and re-bleeding were independent factors of mortality by time-dependent Cox-regression model. Asthenia was the most common adverse event and was higher in group B (p <0.001).

Conclusions

Adding NSBB therapy to repeated GVO provides no benefit for the secondary prevention of bleeding and mortality in patients with GVB.