The Comparision of Propranolol Monotherapy and Propranolol , Isosorbide-5-mononitrate and Metoclopramide Triple Therapy after Endoscopic Sclerotherapy in Patients with Esophageal Variceal Bleeding / 대한간학회지

ABSTRACT

BACKGROUND/AIMS: Hemorrlmge from esophageal varices is a catastrophic complication of portal hypertension. Sclentherapy and/or pharmacological reatment have been used in the primary and secondary pevention of hemorrhages in high-risk cirrhotic patients. We compared the efficacy of propranolol with the efficacy of propranolol plus isosorbide mononitrate plus metoclopramide for the prevention of variceal rebleeding METHODS: Forty-six hospitalized patients with cirrhosis and bleeding from esaphageal varices were treated with mhscopic sclerotherapy and randomly assigned to treatment with propranolol (25 patients group 1) or propranolol plus isosorbide-5-mononitrate plus metoclopramide (21 patients group 2). The primary outcomes were rebleeding and death. RESULTS: Base-line data were similar in the two groups, and the median follow-up was 15.4 months. Seventeen (68%) of 25 patients in group 1 and 11 (52%) of 21 patients in group 2 had repeated bleeding from varices during the follow-up period, but thae were no significant statistical differences between two groups. 1 he 2-year survival rate of both poups were 56% (14/25) in poup 1 and 62% (13/21) in group 2 during follow-up period. The causes of death in both groups wererebleeding (6/11 group 1 vs 3/8 group 2), hepatic failure (3/11 group 1 vs 3/8 group 2), and hepatoma (1/11 group 1 vs 1/8 group 2). CONCLUSIONS: Propranolol plus isosorbide mononitrate plus metoclopramide triple therapy did not differ from propranolol monotherapy in the aspects of rebleeding and survival in patients with esophageal variceal bleeding after endoscopic sclerotherapy, although the former revealed the tendency of the decrease in rebleeding and mortality rate.