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Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis
The use of beta-blockers in decompensated cirrhosis accompanying ascites is still under debate. The aim of this study was to compare overall survival (OS) and incidence of cirrhotic complications between endoscopic variceal ligation (EVL) only and EVL + non-selective beta-blocker (NSBB) combination...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004788/ https://www.ncbi.nlm.nih.gov/pubmed/32000397 http://dx.doi.org/10.1097/MD.0000000000018913 |
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author | Yoo, Jeong-Ju Kim, Sang Gyune Kim, Young Seok Lee, Bora Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Jun, Baek-Gyu Kim, Young Don Cheon, Gab Jin |
author_facet | Yoo, Jeong-Ju Kim, Sang Gyune Kim, Young Seok Lee, Bora Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Jun, Baek-Gyu Kim, Young Don Cheon, Gab Jin |
author_sort | Yoo, Jeong-Ju |
collection | PubMed |
description | The use of beta-blockers in decompensated cirrhosis accompanying ascites is still under debate. The aim of this study was to compare overall survival (OS) and incidence of cirrhotic complications between endoscopic variceal ligation (EVL) only and EVL + non-selective beta-blocker (NSBB) combination therapy in cirrhotic patients with significant ascites (≥grade 2). This retrospective study included 271 consecutive cirrhotic patients with ascites who were treated with EVL only or EVL + NSBB combination therapy as a primary prophylaxis of esophageal varices. The primary outcome was all-cause mortality. Propensity score matching was performed between the 2 groups to minimize baseline difference. Median observation period was 42.1 months (interquartile range, 18.4–75.1 months). All patients had deteriorated liver function: 81.1% Child-Pugh class B and 18.9% Child-Pugh class C. All-cause mortality was significantly higher in the EVL + NSBB group than in the EVL only group not only in non-matched cohort, but also in matched cohort (48.9% vs 31.2%; P = .039). More people died from hepatic failure in the EVL + NSBB group than that in the EVL only group (40.5% vs 20.0%; P = .020). However, the incidence of variceal bleeding, hepatorenal syndrome (HRS), or spontaneous bacterial peritonitis (SBP) was not significantly different between the 2 groups. The use of NSBB might worsen the prognosis of cirrhotic patients with significant ascites. These results suggest that EVL alone is a more appropriate treatment option for prophylaxis of esophageal varices than propranolol combination therapy when patients have significant ascites. |
format | Online Article Text |
id | pubmed-7004788 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-70047882020-02-19 Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis Yoo, Jeong-Ju Kim, Sang Gyune Kim, Young Seok Lee, Bora Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Jun, Baek-Gyu Kim, Young Don Cheon, Gab Jin Medicine (Baltimore) 4500 The use of beta-blockers in decompensated cirrhosis accompanying ascites is still under debate. The aim of this study was to compare overall survival (OS) and incidence of cirrhotic complications between endoscopic variceal ligation (EVL) only and EVL + non-selective beta-blocker (NSBB) combination therapy in cirrhotic patients with significant ascites (≥grade 2). This retrospective study included 271 consecutive cirrhotic patients with ascites who were treated with EVL only or EVL + NSBB combination therapy as a primary prophylaxis of esophageal varices. The primary outcome was all-cause mortality. Propensity score matching was performed between the 2 groups to minimize baseline difference. Median observation period was 42.1 months (interquartile range, 18.4–75.1 months). All patients had deteriorated liver function: 81.1% Child-Pugh class B and 18.9% Child-Pugh class C. All-cause mortality was significantly higher in the EVL + NSBB group than in the EVL only group not only in non-matched cohort, but also in matched cohort (48.9% vs 31.2%; P = .039). More people died from hepatic failure in the EVL + NSBB group than that in the EVL only group (40.5% vs 20.0%; P = .020). However, the incidence of variceal bleeding, hepatorenal syndrome (HRS), or spontaneous bacterial peritonitis (SBP) was not significantly different between the 2 groups. The use of NSBB might worsen the prognosis of cirrhotic patients with significant ascites. These results suggest that EVL alone is a more appropriate treatment option for prophylaxis of esophageal varices than propranolol combination therapy when patients have significant ascites. Wolters Kluwer Health 2020-01-31 /pmc/articles/PMC7004788/ /pubmed/32000397 http://dx.doi.org/10.1097/MD.0000000000018913 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | 4500 Yoo, Jeong-Ju Kim, Sang Gyune Kim, Young Seok Lee, Bora Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Jun, Baek-Gyu Kim, Young Don Cheon, Gab Jin Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis |
title | Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis |
title_full | Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis |
title_fullStr | Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis |
title_full_unstemmed | Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis |
title_short | Propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: Propensity score matching analysis |
title_sort | propranolol plus endoscopic ligation for variceal bleeding in patients with significant ascites: propensity score matching analysis |
topic | 4500 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004788/ https://www.ncbi.nlm.nih.gov/pubmed/32000397 http://dx.doi.org/10.1097/MD.0000000000018913 |
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