Pfisterer N, et al. - (Re-)bleeding rates and mortality were evaluated in cirrhotic patients who received endoscopic band ligation (EBL) for primary (PP) and secondary prophylaxis (SP) for variceal bleeding. The researchers found EBL alone to be sufficient for PP of variceal bleeding. The addition of non-selective beta-blockers (NSBB) to EBL was correlated with an improved survival within the first 6 months after EBL in SP.

Methods

• The researchers retrospectively evaluated (re-)bleeding rates and mortality with and without concomitant NSBB therapy after first EBL in PP and SP.

Results

• From 01/2005 to 06/2015, 766 patients with oesophageal varices underwent EBL.
• One hundred and one patients (35.6%) received EBL only, while 180 (63.4%) received EBL + NSBBs, among the 284 patients who underwent EBL for PP.
• Among 482 patients on SP, n = 163 (33.8%) received EBL only, while n = 299 (62%) received EBL + NSBBs.
• As compared to EBL alone, concomitant NSBB therapy neither decreased bleeding rates (log-rank: P=0.353) nor mortality (log-rank: P=0.497) in PP.
• In EBL + NSBB vs EBL alone, similar re-bleeding rates were documented (log-rank: P=0.247) in SP.
• EBL + NSBB, however, resulted in a significantly lower mortality rate (log-rank: P < 0.001).
• The competing risk analysis confirmed a decreased risk of death with EBL + NSBB in SP (hazard ratio, HR: 0.50; P < 0.001) but not of rebleeding, transplantation or further decompensation.
• Overall NSBB intake reduced 6-months mortality (HR: 0.53, P=0.008) in SP.
• It was most pronounced in patients without severe/refractory ascites (HR: 0.37; P=0.001) but not observed in patients with severe/refractory ascites (HR: 0.80; P=0.567).