Primary prophylaxis of variceal bleeding in cirrhotic patients: A cohort study

被引：15

作者：

Dell'Era, A. ^{[1
,2
]}

Sotela, J. Cubero ^{[2
]}

Fabris, F. M. ^{[1
,2
]}

Petazzi, G. ^{[1
,2
]}

Reati, R. ^{[1
,2
]}

Iannuzzi, F. ^{[2
]}

Nicolini, A. ^{[3
]}

Rumi, M. G. ^{[2
,4
]}

de Franchis, R. ^{[1
,2
]}

Primignani, M. ^{[1
]}

机构：

[1] IRCCS Osped Maggiore Policlin, Mangiagalli & Regina Elena Fdn, Gastroenterol Unit 3, I-20122 Milan, Italy

[2] Univ Milan, Dept Med Sci, IRCCS Osped Maggiore Policlin, Milan, Italy

[3] IRCCS Osped Maggiore Policlin, Mangiagalli & Regina Elena Fdn, Dept Radiol, I-20122 Milan, Italy

[4] IRCCS Osped Maggiore Policlin, Mangiagalli & Regina Elena Fdn, Gastroenterol Unit 1, I-20122 Milan, Italy

来源：

DIGESTIVE AND LIVER DISEASE | 2008年 / 40卷 / 12期

关键词：

Beta-blockers; Endoscopic band ligation; Hepatic vein pressure gradient; Oesophageal varices;

D O I：

10.1016/j.dld.2008.03.017

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background. Current guidelines recommend beta-blockers for primary prevention of variceal haemorrhage in cirrhotic patients, and band ligation for patients with contraindications or intolerance to beta-blockers. However. it has been suggested that these patients may respond poorly to band ligation. Aim. We evaluated the usefulness of a strategy in which band ligation was used to treat patients with contraindications or intolerance and patients not responding to beta-blockers identified by hepatic vein pressure gradient measurement. Haemodynamic responders and patients refusing hepatic vein pressure gradient measurement were given long-term beta-blockers. Methods. One hundred and thirty-five consecutive patients with high-risk oesophageal varices and no prior bleeding were enrolled. Twenty-five patients with contraindications (group A), 26 with intolerance to beta-blockers (group 13) and 25 showing a poor haemodynamic response (Group C) underwent band ligation. Twenty-two haemodynamic responders (Group D) and 37 refusing hepatic vein pressure gradient measurement (Group E) were treated with beta-blockers. Results. Median follow-up was 32 months. 12/135 patients (8.9%) bled: 3/25 (12%) in group A. 1/26 (3.8%) in group B, 0/25 (0%) in group C, 0/22 (0%) in group D and 8/37 (22.2%) in group E. Mortality was 8/135 (5.9%). Conclusions. Patients with contraindications, intolerance or not responding to beta-blockers treated with band ligation achieve protection from variceal bleeding comparable to that of good responders to beta-blockers. (C) 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

引用

页码：936 / 943

页数：8

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