Carvedilol, Endoscopic Variceal Ligation or Combination of Both for Prevention of First Variceal Bleed in Child's B & C Cirrhosis

Carvedilol, Endoscopic Variceal Ligation or Combination of Both for Prevention of First Variceal Bleed in Child's B & C Cirrhosis: A Randomized Controlled Trial

Study Design: Open labeled randomized controlled trial. The study will be conducted on patients attending outpatient or admitted to admitted to Department of Hepatology from January 2017 to December 2018 at ILBS, New Delhi

Inclusion Criteria:

• Liver Cirrhotics between 18-70 yrs of age (cirrhosis diagnosed on the basis of clinical, biochemical, fibroscan & imaging.)
• CTP ≥ 7-15 (Child's B/C)
• Small esophageal varices with RCS and large esophageal varices (>5 mm)
• No history of previous bleed

Exclusion Criteria:

• Malignancy-HCC, PVT
• Child A
• MELD >35
• Contraindications to β blockers.
• Platelet count < 30,000/mm3
• Previous endoscopic variceal treatment. (Beyond 21 days)
• Patients having an indication for TIPS or requiring more than 1 therapeutic ascitic tapping/month
• Post TIPS, Shunt surgery
• Acute kidney injury (Sr.Cr>1.5mg/dl)
• Non cirrhotic portal hypertension
• Acute on chronic liver failure