COMPARISON OF ENDOSCOPIC BAND LIGATION ALONE VERSUS PROPANALOL PLUS ENDOSCOPIC BAND LIGATION FOR CONTROL OF REBLEEDING OESOPHAGEAL VARICES IN PATIENTS WITH PORTAL HYPERTENSION

Objective: To compare oesophageal varices band ligation alone versus the combination of beta blocker (Propranolol) plus band ligation. Materials and Methods: A randomized control trial was carried out in 150 patients who presented with upper GI bleeding as a complication of cirrhosis of liver. After hemodynamic stabilization in the hospital with pharmacological options and/or band ligation procedures through endoscopy, the patients were randomly distributed in two separate groups at discharge from hospital. Group A had endoscopic band ligation every 4 weeks till obliteration of varices and group B were assigned in a group with both beta blocker and band ligation every 4 weeks. Patients were followed monthly for re-bleeding and other complications for six months. Results: Ascites was observed in 103 (68.66%) patients and 11.3% had hepatic encephalopathy. High grade oesophageal varices was observed in 111 (74%),26 (17.3%) patients had moderate grade varices, while 13 (8.6%) also had fundal varices. Band ligation was done in all the patients. Patients were randomly distributed in Group A and group B having included 76 and 74 patients respectively through the random table. Seven (4.6 %) patients were lost to follow up. Re-bleeding occurred in 19 (12.66%) after 6 months. A total of 35 (23.3 %) died after 6 months but only one death was attributed to re-bleeding. Re-bleeding occurred in 19 (25%) patients in Group A and none in Group B (p = 0.00). Eleven (14.5%) patients in Group A and 8 patients in group B (10.8%) expired due to complications other than          re-bleeding. A significant difference was observed in rebleeding pattern of two groups where more re-bleeding was noted in group A as compared to group B (p =0.02). Conclusion: Endoscopic band ligation plus pharmacological treatment (Propranolol) significantly reduces re-bleeding in patients with oesophageal variceal bleed as compared to band ligation alone.