The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

• Published in: Clinical and molecular hepatology Vol. 19; no. 3; pp. 280 - 287
• Main Authors: Choi, Moon Han, Kim, Young Seok, Kim, Sang Gyune, Lee, Yun Nah, Seo, Yu Ri, Kim, Min Jin, Lee, Sae Hwan, Jeong, Soung Won, Jang, Jae Young, Kim, Hong Soo, Kim, Boo Sung
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of the Liver 01.09.2013; The Korean Association for the Study of the Liver; 대한간학회
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Beta blockers; Beta-blocker; Blood pressure; Catheters; Enbucrilate - therapeutic use; Endoscopy; Endoscopy, Digestive System; Esophageal and Gastric Varices - drug therapy; Esophagus; Female; Follow-Up Studies; Gastric varices; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Heart Rate; Hemodynamics; Hepatitis; Humans; Hypertension; Kaplan-Meier Estimate; Liver diseases; Male; Middle Aged; Mortality; Original; Proportional Hazards Models; Propranolol - therapeutic use; Risk Factors; Secondary prevention; Severity of Illness Index; Statistical analysis; 내과학; Germany; Secondary prevention; Beta-blocker; Gastric varices
• ISSN: 2287-2728; 2287-285X
• DOI: 10.3350/cmh.2013.19.3.280

The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl®. However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study. Ninety-three patients at Soonchunhyang University Hospital with acute GVB who received GVO using Histoacryl® were enrolled between June 2001 and March 2010. Among these, 42 patients underwent GVO alone (GVO group) and 51 patients underwent GVO with adjuvant BB therapy (GVO+BB group). This study was intended for patients in whom a desired heart rate was reached. The rates of rebleeding-free survival and overall survival were calculated for the two study groups using Kaplan-Meyer analysis and Cox's proportional-hazards model. The follow-up period after the initial eradication of gastric varices was 18.14±25.22 months (mean±SD). During the follow-up period, rebleeding occurred in 10 (23.8%) and 21 (41.2%) GVO and GVO+BB patients, respectively, and 39 patients died [23 (54.8%) in the GVO group and 16 (31.4%) in the GVO+BB group]. The mean rebleeding-free survival time did not differ significantly between the GVO and GVO+BB groups (65.40 and 37.40 months, respectively; P=0.774), whereas the mean overall survival time did differ (52.54 and 72.65 months, respectively; P=0.036). Adjuvant BB therapy after GVO using Histoacryl® for the first acute episode of GVB could decrease the mortality rate relative to GVO alone. However, adjuvant BB therapy afforded no benefit for the secondary prevention of rebleeding in GV.