Endoscopic Band Ligation vs Pharmacological Therapy or Both as Secondary Prophylaxis for Esophageal Variceal Bleeding in Chronic Liver Disease Patients
AbstractTo compare beta blocker, endoscopic variceal band ligation (EVBL) and combination of both for prevention of re-bleeding of esophageal varices in chronic liver disease (CLD) patients.
MethodsThis was a randomized controlled trial done at North Medical ward, Mayo hospital, Lahore for 6 months. After ethical approval, 320 patients of ages 18-80 years with either gender admitted with variceal bleed were included in study. After stabilizing with standard treatment of EVBL & beta blocker, patients were randomly divided in four groups, i.e. group I was put on propranolol, group II had EVBL every 2 weekly, group III had EVBL every 4 weekly and group IV had combination of 2 weekly EVBL with beta blocker. All patients were followed for six months. Quantitative variables in four groups were compared by ANOVA test whereas qualitative variables by chi-square test.
Results After 6 months follow up re-bleeding was noted in 10 patients after one month (8 in group I, 2 in group II while no patient rebleed in group III and group IV). 61 (19.06%) patients rebleed after 3 months (40/7/14/0). 107 (33.43%) patients rebleed after 6 months (73/16/18/0 respectively). Significantly more re-bleeding occurred in group I patients whereas no rebleed occurred in group IV patients. No significant difference was noted in group II and III. Overall 7 patients lost the follow up.
Conclusion Combination of beta blocker with EVBL is more effective than EVBL and beta blocker alone in secondary prophylaxis of variceal bleeding in CLD patients.
Keywords:Beta-Blocker, Variceal Bleed, EVBL, CLD, Secondary prophylaxis.
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