Comparison of Endoscopic Variceal Ligation (EVL) With Propranolol in Non Cirrhotic Portal Hypertension (NCPH)
Status:
Completed
Trial end date:
2009-10-01
Target enrollment:
Participant gender:
Summary
Background: Variceal bleeding is a major cause of morbidity and mortality in patients with
Non Cirrhotic Portal Hypertension (NCPH). Beta blockers (BB) and endoscopic variceal ligation
(EVL) have been used to prevent rebleeding in these patients, largely based on data from
cirrhotic patients. Endotherapy in the form of EST has been well studied in preventing
rebleed in patients with NCPH. Initial studies showed that EST significantly reduced the
rebleeding rate in patients of NCPH. Data from these studies suggests a rebleed rate of
approximately 25% at 2yr and 35% at 5 years.
Beta blockers have been found to be quite effective in both primary as well as secondary
prophylaxis of variceal bleeding in cirrhotic and are accepted mode of treatment. In contrast
to liver cirrhosis, published data on the effect of beta blocker therapy on NCPH are scanty.
Animal data and human data suggests that beta blockers reduce portal pressure in patients
with NCPH. In two placebo controlled trials of propranolol on secondary prophylaxis of
variceal bleeding in non cirrhotic patients. both studies demonstrated the efficacy of
propranolol in decreasing rebleed rate. However, no comparisons hae been made with EVL till
date.
Hypothesis: The investigators hypothesis that In patients with NCPH, treatment with beta
blockers will lead to reduction in portal pressure and decrease in portosystemic shunting
leading to reduction in variceal rebleeding Aim of the study: Aim: To compare the efficacy
and safety of Propranolol and EVL in the prevention of variceal rebleeding in patients with
NCPH.