Effectiveness of carvedilol alone versus carvedilol combined with endoscopic variceal ligation in secondary prevention of gastroesophageal variceal bleeding in patients with liver cirrhosis
Journal Title: Journal of Clinical Hepatology - Year 2025, Vol 41, Issue 5
Abstract
[Objective] To compare the therapeutic effects of carvedilol alone and carvedilol combined with endoscopic variceal ligation （EVL） in the prevention of re-bleeding from gastroesophageal varices， and to provide strategies for clinical treatment. [Methods] We retrospectively included 178 patients who had received carvedilol alone or carvedilol plus EVL to prevent gastroesophageal variceal re-hemorrhage from October 2010 to June 2023. They were divided into carvedilol alone group （47 cases） and carvedilol+EVL group （131 cases）. Between-group comparisons were conducted using the paired t test for normally distributed continuous data， the Mann-Whitney U test for non-normally distributed continuous data， and the chi-square test for categorical data. A Cox proportional hazards model was employed for univariable and multi-variable analyses. The cumulative incidence rates of re-bleeding and mortality were estimated using the Kaplan-Meier method. The baseline characteristics of the two groups were matched through propensity score matching （PSM） to reduce selection bias and enhance the credibility of causal inference. [Results] The re-bleeding rate of the carvedilol+EVL group was significantly lower than that of the carvedilol alone group （10-year cumulative incidence： 29.8% vs 36.2%， hazard ratio ［HR］=0.505， 95% confidence interval ［CI］： 0.292 — 0.847， P=0.015）. There was no significant difference in liver-related mortality （10-year cumulative incidence： 21.3% vs 21.4%， HR=0.799， 95%CI： 0.406 — 1.578， P=0.518）. The results were stable with PSM analysis. The Cox regression analysis revealed that creatinine was an independent risk factor affecting re-bleeding （HR=1.004， 95%CI： 1.001 — 1.008， P=0.011） and liver-related mortality （HR=1.004， 95%CI： 1.001 — 1.007， P=0.019）. [Conclusion] Carvedilol combined with EVL is better than carvedilol alone in the prevention of gastroesophageal variceal re-bleeding.
Authors and Affiliations
Xiaochen LIU, Yifu XIA, Chunqing ZHANG
Keywords
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- EP ID EP768533
- DOI 10.12449/JCH250515
- Views 5
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