NEW YORK (Reuters Health) – The effectiveness of gastric variceal obturation for controlling gastric variceal bleeding is not improved with the addition of non-selective beta-blocker therapy, a Taiwanese team reports in the Journal of Hepatology online January 18.
“Active bleeding and re-bleeding are risks of mortality, so better methods of preventing bleeding should be explored and investigated,” comment Dr. Ming-Chih Hou and colleagues with the National Yang-Ming University and Taipei Veterans General Hospital.
The authors explain that gastric variceal obturation (GVO) therapy is the current treatment of choice for gastric variceal bleeding, but cyanoacrylate injection is technically difficult and involves risk of infection and embolism. While treatment with non-selective beta-blockers reduces rebleeding of esophageal varices, they continue, it effectiveness for secondary prevention of gastric variceal bleeding is debatable.
The team investigated the addition of non-selective beta blocker therapy to repeated gastric variceal obturation (GVO) in a randomized trial involving 95 cirrhotic patients with acute gastric variceal bleeding. After primary hemostasis with GVO, they were randomized to receive propranolol or not while undergoing repeated GVO procedures every 3-4 weeks until gastric varices were eradicated.
After a mean follow-up of 18 months, rebleeding occurred in 22 patients in the propranolol arm and in 26 in the GVO-only arm – a non significant difference (p=0.609), the authors report. Similarly, the number of deaths during follow-up was 22 vs 20 in the two groups, respectively, (p=0.766).
“Adding NSBB (non-selective beta-blockers) does not prevent re-bleeding or reduce mortality in GVB (gastric variceal bleeding) patients who undergo repeated GVO but increases adverse effects,” Dr. Hou and colleagues conclude. “Therefore, repeated GVO is the first choice for secondary prevention but additional NSBB is not suggested.”
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