Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices
- Medical Education, Digestive Center, E-DA Hospital, Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, I-Shou University, Taipei, Taiwan
- Correspondence to Professor G-H Lo, Digestive Center, E-DA Hospital, 1, Yi-Da Road, Kaohsiung County 824, Taiwan; ghlo{at}kimo.com
- Revised 3 February 2009
- Accepted 3 March 2009
- Published Online First 21 April 2009
Abstract
Background: Very early rebleeding is frequently encountered in patients with acute oesophageal variceal bleeding. A trial was designed to assess the efficacy and safety in patients with no active bleeding at endoscopy, receiving banding ligation association with terlipressin to prevent very early rebleeding.
Methods: Patients with no active variceal bleeding at endoscopy were evaluated. Eligible patients were randomised to receive terlipressin infusion alone for 5 days (Terlipressin group) or banding ligation plus terlipressin infusion for 2 days (Combined group). Primary endpoints were treatment failure and very early rebleeding.
Results: The terlipressin group was composed of 46 patients and the Combined group was composed of 47 patients. Both groups were comparable in terms of baseline data. Forty-eight-hour haemostasis was achieved in 91% in the Terlipressin group and 98% in the Combined group (p = 0.20). Very early rebleeding within 48–120 h occurred in 7 patients (15%) in the Terlipressin group but not in any patients (0%) in the Combined group (p = 0.006). Treatment failure was 24% in the Terlipressin group and 2% in the Combined group (p = 0.002). Multivariate analysis revealed that treatment (OR 0.081; 95% CI 0.010 to 0.627) was the only predictive factor of very early rebleeding. Blood requirement was significantly lower in the Combined group than in the Terlipressin group. Complications and 6-week survival were similar in both groups.
Conclusions: Combination of banding ligation and terlipressin infusion for 2 days was superior to only infusion of terlipressin for 5 days in the reduction of very early rebleeding and treatment failure in patients with inactive variceal bleeding at endoscopy.
Trial registration number: ISRCTN28353453
Footnotes
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Funding National Science Council (No. 952314B075B001), Taiwan.
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Competing interests None.
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See Commentary, p 1182
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Ethics approval The study was approved by the hospital Ethics Committee.
