TY - JOUR
T1 - Adding banding ligation is effective as rescue therapy to prevent variceal rebleeding in haemodynamic non-responders to pharmacological therapy
AU - González, Antonio
AU - Augustin, Salvador
AU - Dot, Joan
AU - Pérez, Mercedes
AU - Abu-Suboh, Monder
AU - Romero, Alejandro
AU - Segarra, Antoni
AU - Armengol, Josep Ramón
AU - Esteban, Rafael
AU - Guardia, Jaime
AU - Genescà, Joan
PY - 2012/1/1
Y1 - 2012/1/1
N2 - Background: It is unknown which is the best therapy to treat haemodynamic non-responders to pharmacological therapy after variceal bleeding. Aim: To evaluate the efficacy of adding banding ligation to drugs to prevent variceal rebleeding in haemodynamic non-responders to drugs. Methods: Fifty-three cirrhotic patients with variceal bleeding underwent a hepatic venous pressure gradient (HVPG) measurement 5 days after the episode. Nadolol and nitrates were then titrated to maximum tolerated doses. A second HVPG was taken 14 days later. Responders (HVPG ≤12. mm. Hg or ≥20% decrease from baseline) were maintained on drugs and non-responders had banding ligation added to drugs. Results: Mean follow-up was 28 months. In 5 patients the second HVPG could not be performed because of early rebleeding. The remaining 48 patients were classified as responders (n=24) and non-responders (n=24), who had banding added. No baseline differences were observed between groups. Variceal rebleeding occurred in 12% of the 48 patients whose haemodynamic response was assessed. Responders on drug therapy presented a 16% rebleeding rate, whilst non-responders rescued with banding showed an 8% rebleeding rate. Rebleeding-related mortality was not different between groups. Conclusion: In a HVPG-guided strategy, adding banding ligation to drugs is an effective rescue strategy to prevent rebleeding in haemodynamic non-responders to drug therapy. © 2011 Editrice Gastroenterologica Italiana S.r.l..
AB - Background: It is unknown which is the best therapy to treat haemodynamic non-responders to pharmacological therapy after variceal bleeding. Aim: To evaluate the efficacy of adding banding ligation to drugs to prevent variceal rebleeding in haemodynamic non-responders to drugs. Methods: Fifty-three cirrhotic patients with variceal bleeding underwent a hepatic venous pressure gradient (HVPG) measurement 5 days after the episode. Nadolol and nitrates were then titrated to maximum tolerated doses. A second HVPG was taken 14 days later. Responders (HVPG ≤12. mm. Hg or ≥20% decrease from baseline) were maintained on drugs and non-responders had banding ligation added to drugs. Results: Mean follow-up was 28 months. In 5 patients the second HVPG could not be performed because of early rebleeding. The remaining 48 patients were classified as responders (n=24) and non-responders (n=24), who had banding added. No baseline differences were observed between groups. Variceal rebleeding occurred in 12% of the 48 patients whose haemodynamic response was assessed. Responders on drug therapy presented a 16% rebleeding rate, whilst non-responders rescued with banding showed an 8% rebleeding rate. Rebleeding-related mortality was not different between groups. Conclusion: In a HVPG-guided strategy, adding banding ligation to drugs is an effective rescue strategy to prevent rebleeding in haemodynamic non-responders to drug therapy. © 2011 Editrice Gastroenterologica Italiana S.r.l..
KW - Hepatic venous pressure gradient
KW - Liver cirrhosis
KW - Pharmacological therapy
KW - Portal hypertension
KW - Variceal haemorrhage
U2 - 10.1016/j.dld.2011.07.019
DO - 10.1016/j.dld.2011.07.019
M3 - Article
SN - 1590-8658
VL - 44
SP - 55
EP - 60
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
IS - 1
ER -