Aim: to assess whether nadolol could improve the results of sclerotherapy in the prevention of varices rebleeding.
Experimental design: prospective study in which patients with cirrhosis and Child-Pugh's class A or B and with their first hemorrhage from esophageal varices, diagnosed by emergency endoscopy, were included. After initial control of bleeding with emergency sclerotherapy, the patients were randomized into two groups to receive long-term variceal sclerotherapy either alone (group 1) or plus nadolol (group 2). Sclerotherapy was performed by intravariceal injection of 5% ethanolamine at days 0, 4 10, 30 and then monthly until eradication of varices. Nadolol was administered during the whole follow-up in a dose to reduce resting pulse rate by 25% (mean final dose: 82 +/- 31 mg/d).
Patients: During a two year period (1989-1991), 40 patients with cirrhosis (from alcohol abuse in 48%), were included. 18 patients were allocated in group 1 and 22 in group 2.
Results: Both groups were well-matched for clinical, biological and endoscopic data. Follow-up was similar in both (24.3 +/- 10.6 months in group 1 vs 27.3 +/- 9.8 in group 2). Nine patients in group 1 (50%) and 13 in group 2 (59%) rebled during the follow-up, with a total number of 14 and 22 rebleeding episodes respectively (p = NS). There were no differences between the two groups when considering rebleeding index, transfusional requirements per rebleeding episode and the cumulative percentage of patients free from rebleeding. Severe complications attributable to treatment were observed in 22% of patients in group 1 and in 27% in group 2 (p = NS). Two patients died in each group.
Conclusions: In patients undergoing long-term sclerotherapy for prevention of variceal rebleeding, nadolol confers no additional benefit.