CARVEDILOL VS. ENDOSCOPIC BAND LIGATION FOR VARICEAL BLEEDING SECONDARY PROPHYLAXIS; LONG-TERM RCT FOLLOW-UP

IntroductionCarvedilol reduces rates of variceal bleeding and rebleeding by lowering portal pressure. However, an associated pleotropic survival benefit has been proposed. We aim to investigate further by undertaking long-term follow-up of a multicentred randomised control trial.MethodsThe index study randomised 64 cirrhotic patients with clinically confirmed acute oesophageal variceal bleeding between June 2006 and December 2011 to receive either carvedilol or endoscopic band ligation (EBL).1 We reviewed electronic patient records for all patients up to 31/04/2020 and updated the previously defined clinically relevant outcomes.ResultsOf those randomised, 26 out of 33 participants received carvedilol in the follow-up period and 28 out of 31 attended for regular EBL sessions. There were no significant differences in baseline characteristics between groups. Mean follow-up for all participants was 2217 days. The mean duration of carvedilol administration was 1267 days. On intention to treat analysis, there was a trend towards improved survival in the carvedilol group, but this did not reach statistical significance (p=0.09). However, on per-protocol analysis, carvedilol administration was significantly associated with improved long-term survival (p<0.01), as well as fewer liver related deaths (4% vs 29%, p=0.02, OR=0.1) and fewer participants experiencing a hospital admission with decompensated liver disease (11% vs 50%, p<0.01, OR=0.13) compared to the EBL group, respectively. There were no statistically significant differences in other adverse outcomes between carvedilol and EBL groups, including variceal rebleeding (39% vs 32%, p=0.78, OR=1.3).ConclusionFollowing an acute variceal bleed in cirrhotic patients, carvedilol is associated with survival benefit and fewer hospital admissions. Further studies are needed to validate this finding and explore the potential benefit in other patient groups.ReferenceStanley AJ, Dickson S, Hayes PC, et al. Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding. J Hepatol. 2014;61(5):1014-1019.