医学
肝细胞癌
内科学
胃肠病学
肝硬化
失代偿
门脉高压
胃静脉曲张
食管静脉曲张
作者
Tsung‐Chieh Yang,Wen‐Chi Chen,Ming‐Chih Hou,Ping‐Hsien Chen,Pei‐Chang Lee,Chung‐Yu Chang,Hsiao‐Sheng Lu,Yu-Jen Chen,Shao‐Jung Hsu,Hui‐Chun Huang,Jiing‐Chyuan Luo,Yi‐Hsiang Huang,Fa-Yauh Lee
出处
期刊:Gut
[BMJ]
日期:2023-12-14
卷期号:: gutjnl-330419
被引量:1
标识
DOI:10.1136/gutjnl-2023-330419
摘要
Objective This randomised trial aimed to address whether endoscopic variceal ligation (EVL) or propranolol (PPL) is more effective at preventing initial oesophageal variceal bleeding (EVB) in patients with hepatocellular carcinoma (HCC). Design Patients with HCC and medium-to-large oesophageal varices (EVs) but without previous EVB were randomised to receive EVL (every 3–4 weeks until variceal eradication) or PPL (up to 320 mg daily) at a 1:1 ratio. Long-term follow-up data on EVB, other upper gastrointestinal bleeding (UGIB), non-bleeding liver decompensation, overall survival (OS) and adverse events (AEs) were analysed using competing risk regression. Results Between June 2011 and April 2021, 144 patients were randomised to receive EVL (n=72) or PPL (n=72). In the EVL group, 7 patients experienced EVB, and 30 died; in the PPL group, 19 patients had EVB, and 40 died. The EVL group had a lower cumulative incidence of EVB (Gray’s test, p=0.009) than its counterpart, with no mortality difference (Gray’s test, p=0.085). For patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B, EVL was better than PPL in reducing EVB (p<0.001) and mortality (p=0.003). For patients beyond BCLC stage B, between-group outcomes were similar. Other UGIB, non-bleeding liver decompensation and AEs did not differ between groups. A competing risk regression model confirmed the prognostic value of EVL. Conclusion EVL is superior to PPL in preventing initial EVB in patients with HCC. The benefits of EVL on EVB and OS may be limited to patients with BCLC stage A/B and not to those with BCLC stage C/D. Trial registration number NCT01970748 .
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