@article {169901, title = {Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding.}, journal = {Hepatology international}, volume = {12}, year = {2018}, note = {n/a}, month = {2018 Jan}, pages = {75-82}, 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.

}, keywords = {Adrenergic beta-Antagonists, Adult, Aged, Carbazoles, Carvedilol, Egypt, Esophageal and Gastric Varices, Female, Gastrointestinal Hemorrhage, Humans, Ligation, Male, Middle Aged, Propanolamines, Propranolol, Treatment Outcome}, issn = {1936-0541}, doi = {10.1007/s12072-017-9835-9}, author = {Ayman Yosry Abd ElRahim and Fouad, Rabab and Khairy, Marwa and Elsharkawy, Aisha and Fathalah, Waleed and Khatamish, Haytham and OMAYMA KHORSHID and Moussa, Mona and Seyam, Moataz} }