A prospective randomized study to evaluate propranolol in patients undergoing long-term endoscopic sclerotherapy

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Pharmacology

Background:

• Portal hypertension increases the risk of variceal bleeding.
• Endoscopic sclerotherapy (EST) is a common treatment for variceal bleeding.
• Propranolol is used to manage portal hypertension, but its benefit alongside EST is unclear.

Purpose of the Study:

• To evaluate the efficacy of propranolol in patients with portal hypertension undergoing long-term EST.
• To determine if propranolol reduces rebleeding rates or improves outcomes in this patient population.

Main Methods:

• Prospective randomized double-blind study.
• Inclusion of patients with portal hypertension (Child's A or B) due to cirrhosis, non-cirrhotic portal fibrosis, or extrahepatic portal venous obstruction.
• Comparison of weekly EST with placebo versus weekly EST with propranolol.

Main Results:

• No significant difference in rebleeding rates between the propranolol and placebo groups (17% vs 21%).
• Similar median bleeding-free periods, transfusion requirements, hospital admissions, and variceal obliteration rates.
• No significant difference in mortality or recurrence of new varices between groups.
• Additional adverse effects were noted in the propranolol group.

Conclusions:

• The addition of propranolol to long-term EST for portal hypertension does not provide additional benefit.
• Propranolol does not significantly reduce rebleeding or improve outcomes in patients with fair hepatic function undergoing EST.
• Further research may be needed to explore alternative or combination therapies.