Análisis crítico de un artículo / Critical appraisal: Band ligation and propranolol are equally effective for primary prevention of variceal bleeding
Rev. méd. Chile
;
132(12): 1561-1564, dez. 2004. tab
Artigo
em Espanhol
| LILACS
| ID: lil-394458
ABSTRACT
In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n=75) or PPL (n=77). The groups were well matched with respect to baseline characteristics (age 56±10 years, alcoholic etiology 51%, Child-Pugh score 7.2±1.8). The mean follow-up was 34±19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment.
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Propranolol
/
Varizes Esofágicas e Gástricas
/
Antagonistas Adrenérgicos beta
/
Medicina Baseada em Evidências
/
Hemorragia Gastrointestinal
Tipo de estudo:
Ensaio Clínico Controlado
Limite:
Humanos
Idioma:
Espanhol
Revista:
Rev. méd. Chile
Assunto da revista:
Medicina
Ano de publicação:
2004
Tipo de documento:
Artigo
País de afiliação:
Chile
Instituição/País de afiliação:
Pontificia Universidad Católica de Chile/CL
Similares
MEDLINE
...
LILACS
LIS