Journal zyxwvutsrqp of Gastroenterology and Hepatology zyxwvutsrqp (1993) 8, 358-362 LIVER AND BILIARY zyxw Does propranolol maintain post-sclerotherapy var,ceal obliteration? A prospective randomized study GIN-HO LO,' KWOK-HUNG LAI,' SHOU-DONG LEE,' YANG-TE TSA13 AND KWANG- JUEI LO' Division of Gastroenterology, Department of Medicine, Veterans General Hospital-'Kaohsiung, 'Taipei and Taichung, and National Yang-Ming Medical College, Taipei, Taiwan, Republic of China Abstract Variceal recurrence and rebleeding are common after initial obliteration by injection sclerother- apy. To investigate whether propranolol can maintain variceal obliteration by sclerotherapy, 59 patients with oesophageal variceal bleeding after sclerotherapy were enrolled. Patients were allocated to propranolol treatment (30 patients) or served as controls (29 patients). After a mean follow up of 2 years and 4 months, 53 patients completed the study. Fifty-eight per cent of the propranolol group versus zyxw 77% of the control group experienced recurrent varices (P zyxwvuts = 0.20). Fifteen per cent of the propranolol group versus 11% of the control group developed cardiac varices. Recurrent variceal bleeding was encountered in 27% of the propranolol group and 19% of the control group. Three patients in the propranolol group, compared with two patients in the control group, died of massive variceal bleeding. Eighty per cent of them bled from cardiac varices. Both groups had similar survival rates. We therefore concluded that the use of propranolol after variceal obliteration by sclerotherapy can neither prevent oesophagogastric variceal recurrence nor prevent further rebleeding. Key words: propranolol, sclerotherapy, variceal obliteration, variceal recurrence. INTRODUCTION Oesophageal variceal bleeding is a serious complication of portal hypertension, in which mortality is high.' Endoscopic injection sclerotherapy (EIS) has been well- documented as a valuable tool to help control acute variceal bleeding, prevent recurrent bleeding, and even improve Oral propranolol has also been shown to reduce portal hypertension in cirrhotic patients.' Although the results of controlled trials of propranolol are contradict~ry,~-" it is still a preferred option in attempts to prevent recurrent variceal bleeding. Prior to variceal obliteration, propranolol had also been used in an attempt to prevent rebleeding during the course of EIS. However the results were also conflicting. ' *-I3 Variceal recurrence and rebleeding are common after initial obliteration by EIS and are of great concern to scler~therapists.'~-' It is still unknown whether propranolol can maintain post-sclerotherapy va- riceal obliteration and prevent further rebleeding. There- fore, this randomized, prospective study was conducted to evaluate the role of propranolol in patients with variceal obliteration achieved by EIS. METHODS Between March 1985 and July 1988, 59 patients who had had complete obliteration of oesophageal varices were enrolled in this study. All of them had presented with oesophageal variceal bleeding and had received regular EIS. The EIS technique used on the patients has been described in detail elsewhere.' Briefly intravariceal injec- tion of a sclerosing agent by free-hand technique (an even mixture of 3% sodium tetradecyl sulfate and zy 50% dex- trose in water) was employed. The interval between two sessions of EIS was 2-3 weeks. All the patients met the following criteria: (i) no visible residual oesophagogastric varices (checked by two experienced endoscopists); (ii) no association with cancer growth on entry; (iii) no known contraindications to P-blockade; (iv) P-blockers were not received prior to variceal obliteration; and (v) informed consent was obtained. Upon achievement of variceal obliteration, the patients were randomly allocated by sealed envelopes either to receive propranolol or to serve as controls. Propranolol was administered in two or three daily divided doses necessary to reduce the heart rate by 25%. The mean dosage was 110 ? 16 mg per day (range 60-320 mg). Correspondence: Gin-Ho Lo, MD, Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Kaohsiung, Accepted for publication zyxwvutsr 15 February 1993. 386 Ta-Chung 1st Rd, Kaohsiung 8 13, Taiwan, Republic of China.