de la Peña J et al. (2005) Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology 41: 572–578

Patients suffering from portal hypertension are at high risk of repeated episodes of variceal bleeding. Current therapeutic options for preventing secondary episodes of hemorrhage of esophageal varices include β-blockers and endoscopic treatment by endoscopic variceal ligation (EVL). Although studies have shown that EVL is efficient at diminishing variceal rebleeding, variceal episodes recur at a rate of 29–50% within the first year.

de la Peña et al. investigated the efficacy of combination therapy with EVL and the β-blocker nadolol compared with EVL alone in patients at risk of variceal rebleeding. Cirrhotic patients aged 18–75 years with acute variceal bleeding were randomly assigned to receive EVL sessions and 40 mg nadolol daily (increasing doses until a 25% decrease in heart rate was achieved) or EVL sessions alone. After a median follow-up period of 16 months, variceal rebleeding was observed in 14% of patients receiving EVL and nadolol, compared with 38% of patients receiving EVL alone (P = 0.006). Analyses showed that the probability of variceal rebleeding within the first year of follow-up was also lower in the patient group treated with nadolol plus EVL, compared with EVL alone (54% vs 77%, P = 0.06). Mortality rates were comparable between the two groups of patients, as were the numbers of EVL sessions necessary to eradicate esophageal varices. Adverse events were observed in 11% of patients receiving nadolol and EVL.

The authors conclude that nadolol plus EVL is efficient in reducing variceal rebleeding.