BOSTON — Carvedilol is more effective than band ligation in preventing the first bleed from esophageal varices, Dr. Dhiraj Tripathi said at the annual meeting of the American Association for the Study of Liver Diseases.
Because the drug is also well tolerated, “it should be the first line of treatment for primary prophylaxis in these patients,” said Dr. Tripathi of the Royal Infirmary, Edinburgh.
His randomized, controlled trial included 152 patients with esophageal varices of grade II or larger that had not previously bled. The patients' mean age was 54 years, and 72% had cirrhosis due to alcoholic liver disease. The mean Child-Pugh Score was 8.
Patients were randomized to variceal band ligation performed twice weekly until eradication (77 patients) or to carvedilol at 6.25 mg/day for 1 week, up to 12.5 mg/day or as tolerated (75 patients).
By 24 months, a significantly higher percentage of the patients on carvedilol were free from a first variceal bleed (87% vs. 78%, respectively). No significant differences were seen in overall mortality or mortality from variceal bleeding.
Three patients did not tolerate the carvedilol dose escalation, and 10 withdrew from that arm because of side effects, mostly gastrointestinal effects and shortness of breath. Dr. Tripathi noted that the 10% withdrawal rate was significantly lower than the 30% rate that had been seen in studies of propranolol for variceal bleeding prophylaxis (Gastroenterology 2002;123:735–44).
Variceal eradication with banding was successful in 57% of patients. Dr. Tripathi said banding ligation remains a good option “for patients who can't tolerate β-blockers, or who would have problems with compliance.”
Dr. Tripathi had no disclosures related to the study drug.