Beta-blockers for Prevention Of Growth Of Small Esophageal Varices In Cirrhosis: An Randomized Controlled Trial (RCT)

Early Primary Prophylaxis With Beta-Blockers In Prevention Of Growth Of Small Esophageal Varices In Cirrhosis: A Randomized Controlled Trial

Background and Aims: The efficacy of portal pressure reduction by beta blockers for the management of small (≤5 mm) esophageal varices in patients of cirrhosis is not clear. The present randomized controlled trial aims to address these issues. The investigators also assessed the utility of serial HVPG measurements in these patients.

Patients and Methods: Consecutive patients with cirrhosis with small varices, with no history of variceal bleed, were randomized to receive propranolol or placebo. These patients were further randomized to undergo no HVPG, only baseline HVPG, or serial HVPG measurement. Propranolol was titrated to reduce heart-rate to 55/min.

Inclusion Criteria:

• A clinical, radiological or histologic diagnosis of cirrhosis was made
• Age was between 18 and 70 years
• Esophageal varices were small (i.e. ≤5 mm or of grade 1 or 2 according to Conn et al).

Exclusion Criteria:

• Presence of previous variceal bleeding
• Previous medical, surgical or endoscopic treatment for portal hypertension
• Child-Pugh score >13
• Neoplastic disease of any site
• Splenic or portal vein thrombosis
• Concurrent illnesses expected to decrease life expectancy to less than one year
• Pregnancy
• Contraindication to beta-blockers (atrioventricular block, sinus bradycardia with heart rate <50 beats per minute, arterial hypotension with systolic blood pressure <90 mm Hg, heart failure, asthma, peripheral arterial disease, or diabetes needing insulin treatment)
• Concurrent anti-viral treatment during the study period
• Inability to perform follow-up
• Failure to give consent to participate in the study.