Z Gastroenterol 2018; 56(05): e41
DOI: 10.1055/s-0038-1654641
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

The beneficial effects of non-selective betabockers in secondary prophylaxis are most pronounced in patients without refractory ascites

N Pfisterer
1   Krankenanstalt Rudolfstiftung, IV. Med. Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
,
E Fuchs
1   Krankenanstalt Rudolfstiftung, IV. Med. Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
,
M Mandorfer
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
T Pachofszky
1   Krankenanstalt Rudolfstiftung, IV. Med. Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
,
M Bischof
1   Krankenanstalt Rudolfstiftung, IV. Med. Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
,
T Pulgram
1   Krankenanstalt Rudolfstiftung, IV. Med. Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
,
T Bucsics
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
P Schwabl
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
L Sandriesser
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
B Scheiner
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
I Gessl
3   Medical University of Vienna, Division of Rheumatology, Department of Internal Medicine III, Wien, Austria
,
W Dolak
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
A Ferlitsch
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
M Schoeniger-Hekele
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
M Trauner
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
,
M Peck-Radosavljevic
4   Klinikum Klagenfurt am Wörthersee, Dept. of Gastroenterology/Hepatology, Endocrinology and Nephrology, Wien, Austria
,
C Madl
1   Krankenanstalt Rudolfstiftung, IV. Med. Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
,
T Reiberger
2   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Wien, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
09 May 2018 (online)

Also available at
 

Background and Aims:

Endoscopic band ligation (EBL) is used for primary (PP) and secondary prophylaxis (SP) of variceal bleeding. For SP, current guidelines recommend combined use of non-selective beta-blockers (NSBBs) and EBL for SP, while either NSBB or EBL should be used in PP.

Methods:

(Re-)bleeding rates and mortality were retrospectively assessed with and without concomitant NSBB therapy after first EBL in PP and SP.

Results:

766 patients with esophageal varices underwent EBL from 01/2005 – 06/2015. In PP, among 284 patients undergoing EBL, n = 101 (35.6%) received EBL only, while n = 180 (63.4%) received EBL+NSBBs. In 482 patients on SP, n = 163 (33.8%) received EBL only, while n = 299 (62%) received EBL+NSBBs. In PP, concomitant NSBB therapy neither had an impact on bleeding rates (log-rank p = 0.353) nor on mortality (log-rank p = 0.497) as compared to EBL alone.

Patients in SP with EBL+NSBB showed similar rebleeding rates as compared EBL alone (log-rank p = 0.247). However, in SP, a concomitant NSBB therapy resulted in a significantly lower mortality rate (log-rank p < 0.001) with fewer deaths related to liver failure, bleeding, and infections with EBL+NSBB combination therapy. A decreased risk of death with EBL+NSBB in SP (hazard ratio, HR: 0.50; p < 0.001) but not of rebleeding, transplantation or further decompensation was confirmed by competing risk analysis. Interestingly, in SP, NSBB intake reduced 6-months mortality (HR: 0.53, p = 0.008) in patients without severe/refractory ascites (HR: 0.37; p = 0.001) only but this effect was not seen in patients with severe/refractory ascites (HR: 0.80; p = 0.567).

Conclusion:

EBL alone seemed to be sufficient for PP of variceal bleeding. In SP, concomitant NSBB to EBL improves survival within the first 6 months after EBL, as compared to EBL alone. In patients with severe/refractory ascites these beneficial effects of NSBB therapy have to be weighted against their potential side-effects.