Endoscopic variceal ligation versus pharmacologic treatment for primary prophylaxis of variceal bleeding: A randomised study

BACKGROUND AND AIM: Bleeding varices is a major complication of liver cirrhosis; 30 70% may die from the effect of the first bleed. Primary prophylax~is is therefore an important therapeutic goal. The aim of this study is to compare Endoscopic Variceal Ligation (EVL) with medical treatment for the prevention of the first episode of variceal bleeding. METHODS: 156 cirrhotic patients with risky varices were prospectively randomized to receive either EVL (51 patients), propranolol (52 patients) or Isosorbid-5-Mono-Nitrate (ISMN) (53 patients). And follow-up for 18 24 months for bleeding episodes and or mortality. RESULTS: There was no statistically significant difference between the 3 groups as regard sex, age, Child score, etiology of cirrhosis and grade of varices. Bleeding occurred in 4 (7.5%) in EVL group, 18 (34.6%) in ISMN group and 13 (25.5%) in propranolol group. There was no difference in mortality when the 3 groups were compared (7.5% vs 11.5% vs 9.8%), P 0.78. Complications or side effects were reported in 28.3% in EVL compared to 34.6% with ISMN and 39.2% for propranolol. CONCLUSION: In patients with high risk esophageal varices, EVL is more effective and safer than propranolol which is more effective than ISMN for primary prophylaxis of variceal bleeding.