PMID- 38123994
OWN - NLM
STAT- MEDLINE
DCOM- 20240311
LR  - 20240313
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 73
IP  - 4
DP  - 2024 Mar 7
TI  - Endoscopic variceal ligation versus propranolol for the primary prevention of 
      oesophageal variceal bleeding in patients with hepatocellular carcinoma: an 
      open-label, two-centre, randomised controlled trial.
PG  - 682-690
LID - 10.1136/gutjnl-2023-330419 [doi]
AB  - 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.
CI  - (c) Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Yang, Tsung-Chieh
AU  - Yang TC
AUID- ORCID: 0000-0002-5144-2066
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Chen, Wen-Chi
AU  - Chen WC
AUID- ORCID: 0000-0002-7572-4201
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung 
      Veterans General Hospital, Kaohsiung, Taiwan.
AD  - Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, 
      Kaohsiung, Taiwan.
FAU - Hou, Ming-Chih
AU  - Hou MC
AUID- ORCID: 0000-0002-4886-0718
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan mchou@vghtpe.gov.tw.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Chen, Ping-Hsien
AU  - Chen PH
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, 
      Taipei, Taiwan.
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, West Garden 
      Hospital, Taipei, Taiwan.
FAU - Lee, Pei-Chang
AU  - Lee PC
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Chang, Chung-Yu
AU  - Chang CY
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
AD  - Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Lu, Hsiao-Sheng
AU  - Lu HS
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Chen, Yu-Jen
AU  - Chen YJ
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Hsu, Shao-Jung
AU  - Hsu SJ
AUID- ORCID: 0000-0003-4884-634X
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Huang, Hui-Chun
AU  - Huang HC
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
FAU - Luo, Jiing-Chyuan
AU  - Luo JC
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
FAU - Huang, Yi-Hsiang
AU  - Huang YH
AUID- ORCID: 0000-0001-5241-5425
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan.
AD  - Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, 
      Taiwan.
FAU - Lee, Fa-Yauh
AU  - Lee FY
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Taipei 
      Veterans General Hospital, Taipei, Taiwan.
AD  - School of Medicine, College of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
AD  - Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, 
      Taipei Veterans General Hospital, Taipei, Taiwan.
LA  - eng
SI  - ClinicalTrials.gov/NCT01970748
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20240307
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
RN  - 9Y8NXQ24VQ (Propranolol)
SB  - IM
MH  - Humans
MH  - *Carcinoma, Hepatocellular/complications/surgery
MH  - *Esophageal and Gastric Varices/complications/surgery
MH  - Gastrointestinal Hemorrhage/etiology/prevention & control
MH  - Ligation/adverse effects
MH  - *Liver Neoplasms/complications/surgery
MH  - Primary Prevention
MH  - Propranolol/therapeutic use
OTO - NOTNLM
OT  - HEPATOCELLULAR CARCINOMA
OT  - OESOPHAGEAL VARICES
OT  - PORTAL HYPERTENSION
COIS- Competing interests: None declared.
EDAT- 2023/12/21 00:41
MHDA- 2024/03/11 06:44
CRDT- 2023/12/20 23:56
PHST- 2023/06/04 00:00 [received]
PHST- 2023/11/21 00:00 [accepted]
PHST- 2024/03/11 06:44 [medline]
PHST- 2023/12/21 00:41 [pubmed]
PHST- 2023/12/20 23:56 [entrez]
AID - gutjnl-2023-330419 [pii]
AID - 10.1136/gutjnl-2023-330419 [doi]
PST - epublish
SO  - Gut. 2024 Mar 7;73(4):682-690. doi: 10.1136/gutjnl-2023-330419.