CARRY ON WITH THE PILLS

Norberto L, Polese L, Cillo U, et al. A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation. Liver Transp 2007;13:1272–8.

Although beta-blockers have a proven efficacy in preventing bleeding from varices, significant numbers of patients have either contraindications or intolerance to these drugs. Endoscopic variceal ligation can obliterate varices within about a month and hence ligation offers a distinct advantage over long-term treatment with propranolol. Norberto et al conducted a randomised controlled trial comparing these two interventions for patients awaiting liver transplantation.

Sixty-two patients (mean age 52.6 years) with Child B-C cirrhosis (32 due to hepatitis C) and high-risk varices were randomised to receive propranolol or banding. During a mean follow-up period of 14.6 months there was no significant difference between the two groups in overall mortality (three in each group) and transplantation rate (14 vs 10 in the banding and propranolol groups, respectively). One patient in the banding group and two receiving propranolol died due to bleeding. Adverse events (two instances of post-banding ulcer bleeding and five of drug intolerance) were similar in the two groups. However, the cost of banding (US$4289 (SD 285); £2114 (SD 140); €3023 (SD 201)) was significantly higher than the cost of beta-blocker treatment (US$1425 …