Comparison of Endoscopic Variceal Ligation (EVL) With Propranolol in Non Cirrhotic Portal Hypertension (NCPH)

Last updated: December 21, 2010
Sponsor: Govind Ballabh Pant Hospital
Overall Status: Completed

Phase

3

Condition

Stress

Vascular Diseases

Circulation Disorders

Treatment

N/A

Clinical Study ID

NCT01000779
NG001
  • Ages 2-75
  • All Genders

Study 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.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients with Non Cirrhotic Portal Hypertension (NCPH) presenting to our LiverDiseases Follow-up Clinic with history of hemetemesis and/or malena within the past 6weeks and proven to have esophageal varices as the bleeding source on upper GIendoscopy

Exclusion

Exclusion Criteria:

  • A history of surgery for portal hypertension

  • Patients already on a EST, EVL, or glue injection program before presenting to ourhospital

  • Patients already on beta blockers for primary prophylaxis of variceal bleed

  • Severe cardiopulmonary or renal disease

  • Bradycardia (basal heart rate, <50 beats per minute [bpm]) or complete heart block

  • A history of severe side effects or contraindications to β- blockers, like bronchialasthma, diabetes mellitus, heart failure, peripheral vascular disease, prostatichypertrophy, or arterial hypotension (systolic blood pressure <90 mm Hg)

  • Refusal to give informed written consent to participate in the trial

  • Patients bleeding from gastric varices or Portal Hypertensive Gastropathy (PHG).

  • Patients who had a failure of primary hemostasis during acute bleed were alsoexcluded.

Study Design

Total Participants: 100
Study Start date:
January 01, 2005
Estimated Completion Date:
October 31, 2009

Connect with a study center

  • Department of Gastroenterology, GB Pant Hospital,

    New Delhi, Delhi 110002
    India

    Site Not Available

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