Bonilha Danielle Queiroz, Lenz Luciano, Correia Lucianna Motta, Rodrigues Rodrigo Azevedo, de Paulo Gustavo Andrade, Ferrari Angelo Paulo, Della Libera Ermelindo
aDivision of Gastroenterology, Federal University of São Paulo bEndoscopy Division, Fleury Medicina e Saúde cEndoscopy Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Eur J Gastroenterol Hepatol. 2015 Jan;27(1):84-90. doi: 10.1097/MEG.0000000000000227.
The aim of this study was to compare the recurrence of esophageal varices (EVs) after endoscopic band ligation (EBL) associated with propranolol (PP) versus EBL alone.
Sixty-six cirrhotic outpatients (EBL group, n=32 and EBL+PP group, n=34) with high-risk EVs without previous bleeding were studied.
The primary outcome was recurrence of EV. The secondary outcomes were EV eradication, bleeding before EV eradication, mortality, and adverse events.
Demographic characteristics and the initial endoscopic findings were similar. EV eradication was achieved in all patients. Three patients presented gastrointestinal bleeding before variceal eradication, two in the EBL group and one in the EBL+PP group (P=0.13). Six patients died (liver failure), two in the EBL group and four in the EBL+PP group (P=0.27). Twelve (38%) patients in the EBL group and three (9%) patients in the EBL+PP group had variceal recurrence. The risk of recurrence of EVs after eradication was significantly higher among patients in the EBL group (P=0.003).
EBL alone and EBL+PP were effective in the primary prophylaxis of bleeding from EVs in cirrhotic patients (EV eradication, bleeding before EV eradication, mortality, and adverse events were similar in both groups). However, variceal recurrence was lower in the EBL+PP group than band ligation alone.
本研究旨在比较内镜下套扎术（EBL）联合普萘洛尔（PP）与单纯EBL术后食管静脉曲张（EVs）的复发情况。
对66例既往无出血史的高危EVs肝硬化门诊患者进行研究（EBL组，n = 32；EBL + PP组，n = 34）。
主要观察指标为EVs复发。次要观察指标为EVs根除、根除前出血、死亡率及不良事件。
两组患者的人口统计学特征和初始内镜检查结果相似。所有患者均实现了EVs根除。3例患者在静脉曲张根除前出现胃肠道出血，EBL组2例，EBL + PP组1例（P = 0.13）。6例患者死亡（肝功能衰竭），EBL组2例，EBL + PP组4例（P = 0.27）。EBL组12例（38%）患者和EBL + PP组3例（9%）患者出现静脉曲张复发。EBL组患者根除后EVs复发风险显著更高（P = 0.003）。
单纯EBL和EBL + PP在肝硬化患者EVs出血的一级预防中均有效（两组患者的EVs根除、根除前出血、死亡率及不良事件相似）。然而，EBL + PP组的静脉曲张复发率低于单纯套扎术组。
