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Adding Ligation to Nadolol Not Beneficial in Variceal Bleeding

In cirrhotic patients with first variceal bleeding, combination linked to higher risk of adverse events

THURSDAY, June 17 (HealthDay News) -- Combining band ligation with the beta blocker nadolol may increase the odds of adverse events and may not be the most effective prophylaxis for first variceal bleeding from cirrhosis, according to research published in the July issue of Hepatology.

Gin-Ho Lo, M.D., of the E-DA Hospital in Kaohsiung, Taiwan, and colleagues randomized 140 cirrhotic patients with high-risk esophageal varices but no bleeding history to receive either band ligation plus nadolol or nadolol alone to determine the safety and efficacy of the combined treatment.

The researchers found that variceal obliteration was obtained in 50 patients (71 percent) receiving combination therapy. In the median 26-month follow-up period, rates of bleeding were lower, though not significantly lower, in patients receiving only nadolol compared to the combined-therapy group: respectively, 13 (18 percent) and 18 (26 percent) experienced upper gastrointestinal bleeding, and nine (13 percent) and 10 (14 percent) experienced esophageal variceal bleeding. The nadolol-only group, however, experienced far fewer adverse events than the combined-therapy group: 28 (40 percent) versus 48 (68 percent) (P = 0.06). Sixteen patients from each group died.

"In conclusion, our controlled trial disclosed that the addition of ligation to nadolol may increase adverse events and did not enhance effectiveness in the prophylaxis of first variceal bleeding. Beta blockers are still currently the treatment of choice for prophylaxis of first variceal bleeding. The value of endoscopic variceal ligation in the combination therapy requires further investigation," the authors write.

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