Syed Irfan Ahmed, Muzammil Jamil, Muhammad Rizwan Mahmud, Naseemullah M, Muhammad Hanif.
Non-selective Beta-Blockers versus Endoscopic Sclerotherapy for the prevention of variceal hemorrhage in decompensated chronic liver disease.
J Rawal Med Coll Jan ;8(2):61-4.

Background: To gauge the efficacy of non-selective beta-blockers and endoscopic sclerotherapy in the prevention of bleeding from oesophageal varices. Methods: The study was conducted in the Department of Medicine, Holy Family Hospital, Rawalpindi and Specialist Clinics over a three-year period. (January 2001 to December 2003). Fifty-eight patients of decompensated chronic liver disease (CLD) with endoscopically proven F2 and F3 oesophageal varices were included in the study. Thirty-five were male and twenty-three female. All patients were given the option of being treated with either a non-selective beta-blocker orally or endoscopic sclerotherapy. Twenty-six chose beta blockade and were assigned to Group A. Thirty-two preferred sclerotherapy and were allocated Group B. All Group A patients received Nadolol in a dose of 40mg P.O. daily while all individuals in Group B underwent sclerotherapy sessions using absolute ethanol as the sclerosing agent. All patients were followed up for a period of 18 months from the date of first presentation. Any episode of variceal bleed during this period was recorded. Patients in Group A, with no history of variceal haemorrhage prior to inclusion in the study were compared with their counterparts in Group B. A similar comparison was carried out between patients of both groups who had suffered variceal bleed at some point before their inclusion in the study. Results: The average age of patients in Group A was 41.6 years whereas it was 43.2 years in Group B. Of the 26 patients in Group A, 12 had a history of previous variceal bleed while 14 gave no such history. In Group B, patients with a previous bleeding episode numbered 21 while 11 gave no such history. Four (28.8%) of the fourteen patients in Group A with no history of variceal bleed had hematemesis in the subsequent 18 months. Of the 11 patients with no previous bleed in Group B, three (27.3%) had variceal bleeding by the 18th month of follow-up. However, when patients with previous bleeding were considered, 41.7% in Group A compared to 33.3% in Group B suffered variceal bleeding by the end of eighteen months of follow-up. Conclusion: Non-selective beta blockade is as effective as sclerotherapy in preventing oesophageal variceal bleed in patients of decompensated CLD with no bleeding episodes. However sclerotherapy appears to be the better option in preventing variceal bleed in patients with previous bleeding episodes.

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