EFFICACY OF CARVEDILOL COMBINED WITH ENDOSCOPIC VARICEAL LIGATION IN THE PREVENTION OF RECURRENT VARICEAL BLEEDING IN PATIENTS OF CIRRHOSIS

2016 ◽  
pp. 23-30
Author(s):  
Van Huy Tran ◽  
Thi Ngoc Diep Bui
Keyword(s):  
Side Effects ◽  
Beta Blocker ◽  
Variceal Bleeding ◽  
Poor Prognosis ◽  
Oesophageal Varices ◽  
Endoscopic Variceal Ligation ◽  
Efficacy And Safety ◽  
Orthostatic Hypertension ◽  
Key Words Carvedilol ◽  
Very High

Background: The recurrent variceal bleeding is still very high with a very poor prognosis. The combination of a non-selective beta-blocker and endoscopic variceal ligation (EVL) is still a standard therapy for the prevention, but many patients showed no response to propranolol. Carvedilol is a new, non-selective beta-blocker having intrinsic alpha-blocker activity, but the data about the efficacy and safety of carvedilol is still very limited. This study is aimed at assessing the efficacy and safety of carvedilol combined with EVL in the prevention of recurrent variceal bleeding. Patients and methods: 33 patients having variceal bleeding were enrolled. All patients received carvedilol and were performed the EVL until variceal eradication. All the patients were followed after 9 months. Results: rate of variceal eradication of oesophageal varices was 87.88%; the recurrence rate of variceal bleeding was 12.12% after 9 months. The side effects of carvedilol were rare and not severe, including vertiges, headache, and orthostatic hypertension. Conclusion: Carvedilol combined with EVL appeared as a relatively safe and effective in the prevention of recurrent variceal bleeding in patients of cirrhosis. Key words: carvedilol, variceal bleeding, EVL

scholarly journals Comparison of endoscopic variceal ligation and beta-blocker (carvedilol) plus nitrate for the primary prevention of variceal bleeding

2017 ◽  
Vol 4 (4) ◽  
pp. 1053
Author(s):  
Anilesh Kumar Singh Yadav ◽  
Priyadarshi B. P. ◽  
Gupta A. C. ◽  
Mahendra Singh ◽  
Ashok Kumar Verma ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Combination Therapy ◽  
Beta Blocker ◽  
Variceal Bleeding ◽  
Beta Blockers ◽  
Isosorbide Mononitrate ◽  
P Value ◽  
Endoscopic Sclerotherapy ◽  
Endoscopic Variceal Ligation ◽  
Promising Alternative

Background: Esophageal variceal bleed is a major problem in patients with cirrhosis. Endoscopic sclerotherapy and variceal ligation are effective in stopping bleeding in up to 90% of patients. Beta-blocker (Carvedilol) + Isosorbide Mononitrate are promising alternative to other nonselective beta blocker or endoscopic band ligation for the prevention of first variceal bleeding of medium to large varices, which needs to be further explored.Methods: The present study was an observational study in 200 patients at LLR and Associated Hospitals PG Department of Medicine GSVM Medical College, Kanpur. After randomization 120 patients underwent for Endoscopic Variceal ligation and 80 patients were put on beta-blocker (Carvedilol) + Isosorbide Mononitrate therapy for the primary prevention of variceal bleeding.Results: Most common cause of portal hypertension was liver cirrhosis (in carvedilol plus isosorbide mononitrate group 70%, and it was 85%. in EVL group. Bleeding in patients of carvedilol plus isosorbide mononitrate was significantly lower (23.75%) than patients of EVL (60%) group. Reduction in bleeding was statistically highly significant (p value < 0.05). Mortality among patients receiving combination therapy with carvedilol plus isosorbide mononitrate was (12.5%) comparison to EVL (21.66%). Reduction in mortality was statistically not significant. (p value >0.05). Adverse effects were significantly lower among patients receiving combination therapy with carvedilol plus isosorbide mononitrate (38.75%) than patients of EVL (86.66%) group.Conclusions: Both EVL and beta-blockers may be considered first-line treatment to prevent first variceal bleeding, whereas beta-blockers (carvedilol) plus isosorbide mononitrate may be the best choice for the prevention of re-bleeding.

scholarly journals Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Juan Su ◽  
Huilin Zhang ◽  
Maifang Ren ◽  
Yanan Xing ◽  
Yuefei Yin ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Injection Sclerotherapy ◽  
Large Sample Size ◽  
Endoscopic Variceal Ligation ◽  
Efficacy And Safety ◽  
Endoscopic Injection ◽  
Esophageal Variceal Bleeding ◽  
Significant Difference

Objective: To evaluate the efficacy and safety of endoscopic variceal ligation + endoscopic injection sclerotherapy (EVL+EIS) to control acute variceal bleeding (AVB).Methods: Online databases, including Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) disc, VIP, and Wanfang, were searched to identify the studies comparing the differences between EVB+EIS and EVB, EIS from the inception of the databases up to December 30, 2020. STATA 13.0 was used for the meta-analysis.Results: A total of eight studies involving 595 patients (317 patients in the EVL group and 278 patients in the EVL+EIS group) were included. The results of the meta-analysis did not reveal any statistically significant differences in the efficacy of acute bleeding control (P = 0.981), overall rebleeding (P = 0.415), variceal eradication (P = 0.960), and overall mortality (P = 0.314), but a significant difference was noted in the overall complications (P = 0.01).Conclusion: EVL is superior to the combination of EVL and EIS in safety, while no statistically significant differences were detected in efficacy. Further studies should be designed with a large sample size, multiple centers, and randomized controlled trials to assess both clinical interventions.

Efficacy of endoscopic variceal ligation and sclerotheraphy in treatment of acute variceal bleeding

2007 ◽  
Vol 45 (05) ◽  
Author(s):  
C Rédei ◽  
M Szőnyi ◽  
A Zaja ◽  
L Tóth ◽  
Á Svejkovszky ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Endoscopic Variceal Ligation ◽  
Acute Variceal Bleeding

scholarly journals Efficacy and Safety of [225Ac]Ac-PSMA-617 Augmented [177Lu]Lu-PSMA-617 Radioligand Therapy in Patients with Highly Advanced mCRPC with Poor Prognosis

Pharmaceutics ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 722
Author(s):  
Florian Rosar ◽  
Jonas Krause ◽  
Mark Bartholomä ◽  
Stephan Maus ◽  
Tobias Stemler ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Poor Prognosis ◽  
Progression Free Survival ◽  
Tumor Burden ◽  
Efficacy And Safety ◽  
Radioligand Therapy ◽  
Castration Resistant ◽  
Pet Ct ◽  
Visceral Metastases ◽  
Grade 3

The use of 225Ac in prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), either as monotherapy or in combination with 177Lu, is a promising therapy approach in patients with metastatic castration-resistant prostate carcinoma (mCRPC). In this study, we report the efficacy and safety of [225Ac]Ac-PSMA-617 augmented [177Lu]Lu-PSMA-617 RLT in 177Lu-naive mCRPC patients (n = 15) with poor prognosis (presence of visceral metastases, high total tumor burden with diffuse bone metastases or a short PSA doubling time of <2 months). Biochemical (by PSA serum value) and molecular imaging response (by [68Ga]Ga-PSMA-11 PET/CT) was assessed after two cycles of [177Lu]Lu-PSMA-617 RLT, with at least one [225Ac]Ac-PSMA-617 augmentation. In addition, PSA-based progression-free survival (PSA-PFS), overall survival (OS) and toxicity (according to CTCAE) were analyzed. We observed a biochemical- and molecular imaging-based partial remission in 53.3% (8/15) and 66.7% (10/15) of patients, respectively. The median PSA-PFS and OS was 9.1 and 14.8 months, respectively. No serious acute adverse events were recorded. Two out of fifteen patients experienced grade 3 anemia. No other grade 3/4 toxicities were observed. RLT-related xerostomia (grade 1/2) was recorded in 2/15 patients. Our data showed a high clinical efficacy with a favorable side effects profile of [225Ac]Ac-PSMA-617 augmented [177Lu]Lu-PSMA-617 RLT in this highly challenging patient cohort.

Management of variceal bleeding in pregnancy with endoscopic variceal ligation and N-butyl-2-cyanoacrylate: report of three cases

2000 ◽  
Vol 51 (1) ◽  
pp. 91-93 ◽  
Author(s):  
Radha K. Dhiman ◽  
Rakesh Biswas ◽  
Neelam Aggarwal ◽  
Harjit Sawhney ◽  
Yogesh Chawla
Keyword(s):  
Variceal Bleeding ◽  
Endoscopic Variceal Ligation ◽  
In Pregnancy

Tocilizumab in Giant Cell Arteritis: A Multicenter Retrospective Study of 34 Patients

2016 ◽  
Vol 43 (8) ◽  
pp. 1547-1552 ◽  
Author(s):  
Alexis Régent ◽  
Serge Redeker ◽  
Alban Deroux ◽  
Pierre Kieffer ◽  
Kim Heang Ly ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Adverse Events ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Multicenter Study ◽  
Efficacy And Safety ◽  
Severe Adverse Events ◽  
Retrospective Multicenter Study

Objective.To report the efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA).Methods.A retrospective multicenter study that included 34 patients receiving TCZ for GCA.Results.TCZ was effective in all but 6 patients, who still had mild symptoms. Mean glucocorticoid dose was tapered. One patient died and 3 patients had to stop TCZ therapy because of severe adverse events. Twenty-three patients stopped treatment; 8 of these experienced relapses after a mean of 3.5 ± 1.3 months.Conclusion.TCZ is effective in GCA. However, side effects occur. Whether this treatment has only a suspensive effect remains to be determined.

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