beta-Blockers and endoscopic variceal
ligation (EVL) have proven to be valuable methods in the prevention of variceal rebleeding. The aim of this study was to compare the efficacy of EVL combined with
nadolol versus EVL alone as secondary prophylaxis for variceal
bleeding. Patients admitted for acute variceal
bleeding were treated during emergency endoscopy with EVL or
sclerotherapy and received
somatostatin for 5 days. At that point, patients were randomized to receive EVL plus
nadolol or EVL alone. EVL sessions were repeated every 10 to 12 days until the
varices were eradicated. Eighty patients with
cirrhosis (alcoholic origin in 66%) were included (Child-Turcotte-Pugh A, 15%; B, 56%; C, 29%). The median follow-up period was 16 months (range, 1-24 months). The variceal
bleeding recurrence rate was 14% in the EVL plus
nadolol group and 38% in the EVL group (P = .006). Mortality was similar in both groups: five patients (11.6%) died in the combined therapy group and four patients (10.8%) died in the EVL group. There were no significant differences in the number of EVL sessions to eradicate
varices: 3.2 +/- 1.3 in the combined therapy group versus 3.5 +/- 1.3 in the EVL alone group. The actuarial probability of variceal recurrence at 1 year was lower in the EVL plus
nadolol group (54%) than in the EVL group (77%; P = .06). Adverse effects resulting from
nadolol were observed in 11% of the patients. In conclusion,
nadolol plus EVL reduces the incidence of variceal rebleeding compared with EVL alone. A combined treatment could lower the probability of variceal recurrence after eradication.