Comparison between Combination of Band ligation and Propranolol with Propranolol alone in Secondary Prophylaxis of Variceal bleed

Abstract

Introduction: Variceal bleeding is the one of the most important complication of cirrhosis of liver and also the common cause of death in cirrhotics. Cirrhotics with varices have 60% chance of re-bleeding within two years of the index bleed and each re-bleeding episode is associated with a 20% to 35% mortality risk. Endoscopic band ligation and pharmacotherapy are recommended therapeutic modalities for the prevention of secondary variceal re-bleeding. Objective: To compare the efficacy of combination of band ligation and propranolol with propranolol alone in secondary prevention of re-bleed in cirrhotics. Study design: Randomized control trial. Study duration and settings: The study was completed in Medical Unit-II Allied Hospital, Faisalabad for six months from 1^st March 2015 to 31^st August 2015. Methods: A total number of 60 cirrhotic patients with variceal bleed were randomized into two groups, each group containing 30 patients. Group A, receiving a combination of band ligation and propranolol and Group B, receiving propranolol alone. Any evidence of variceal bleed was observed during the research period confirmed by endoscopy. Results: 60 patients were included in the study with a mean age 56.97 ± 5.886. In Group A, 38 (63.3%) were male, 22 (36.7%) were female (table-5). In Group B, 13 (43.3%) were male and 17 (56.7%) were female (table-5). In Group A, bleeding occurred in 3 patients (10%). In Group B, bleeding occurred in 12 patients (40%). P-value was .007. Conclusion: Combination therapy of EBL+propranolol was superior in providing secondary prophylaxis than propranolol alone.