Article Text

Download PDFPDF
Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices
  1. G-H Lo,
  2. W-C Chen,
  3. H-M Wang,
  4. C-K Lin,
  5. H-H Chan,
  6. W-L Tsai,
  7. L-C Cheng,
  8. H-C Yu,
  9. F-W Tsay
  1. Medical Education, Digestive Center, E-DA Hospital, Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, I-Shou University, Taipei, Taiwan
  1. Correspondence to Professor G-H Lo, Digestive Center, E-DA Hospital, 1, Yi-Da Road, Kaohsiung County 824, Taiwan; ghlo{at}


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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding National Science Council (No. 952314B075B001), Taiwan.

  • Competing interests None.

  • See Commentary, p 1182

  • Ethics approval The study was approved by the hospital Ethics Committee.

Linked Articles