Both
nadolol and
ligation have proved to be effective in the prophylaxis of first variceal
bleeding. This study was conducted to evaluate the effects and safety of combining
nadolol with
ligation. Cirrhotic patients with high-risk
esophageal varices but without a
bleeding history were considered for enrolment. Eligible patients were randomized to receive band
ligation plus
nadolol (Combined group, 70 patients) or
nadolol alone (
Nadolol group, 70 patients). In the Combined group multiligators were applied. Patients received regular
ligation treatment at an interval of 4 weeks until variceal obliteration.
Nadolol was administered at a dose to reduce 25% of the pulse rate in both the Combined group and the
Nadolol group. Both groups were comparable in baseline data. In the Combined group 50 patients (71%) achieved variceal obliteration. The mean dose of
nadolol was 52 +/- 16 mg in the Combined group and 56 +/- 19 mg in the
Nadolol group. During a median follow-up of 26 months, 18 patients (26%) in the Combined group and 13 patients (18%) in the
Nadolol group experienced upper gastrointestinal
bleeding (P = NS). Esophageal variceal
bleeding occurred in 10 patients (14%) in the Combined group and nine patients (13%) in the
Nadolol group (P = NS). Adverse events were noted in 48 patients (68%) in the Combined group and 28 patients (40%) in the
Nadolol group (P = 0.06). Sixteen patients in each group died.
CONCLUSION: