The Effect of Hepatic Vein Pressure Gradient(HVPG)-Guided Therapy in Cirrhotic Patients With Esophagogastric Varices
The Effect of Hepatic Vein Pressure Gradient(HVPG)-Guided Therapy in Cirrhotic Patients With Esophagogastric Varices
The purpose of the study is to compare the effect of HVPG-guided individualized therapy and
 non-HVPG guided traditional therapy in cirrhotic patients for secondary prophylaxis.
The study is a randomized controlled trial of Zelen-design. Patients randomly enter two
 treatment groups: 1) the HVPG group and 2) the non-HVPG group. Treatment allocation is by
 block randomization with an equal number for both groups. The results are concealed in opaque
 envelopes.After randomization, patients will have a second chance to decide if they want to
 stay in the current group.Patients can switch to another group according to their will. If
 they are in the HVPG group，they will receive HVPG measurement before treatment. If they are
 in the non-HVPG group, they start treatment without HVPG measurement and receive endoscopic
 treatment plus Carvedilol.The mortality rate and rebleeding rate will be analyzed.
Inclusion Criteria:

 -  Patients with cirrhosis diagnosed by histology, radiological evidence of cirrhosis,
 and endoscopic evidence of varices;

 -  Patients with a previous history of variceal hemorrhage;

 -  Patients admitted to Zhongshan Hospital and other 6 tertiary centers in Shanghai from
 Dec 1, 2015 to Sep 31,2018

 Exclusion Criteria:

 -  Patients already taken secondary prophylactic treatment including endoscopic,
 pharmacological, surgical and interventional therapies;

 -  Patients with severe systemic diseases such as chronic heart failure or chronic renal
 failure that will have impact on survival;

 -  Patients in pregnancy and lactation;

 -  Patients already diagnosed with hepatic cellular carcinoma or other malignant tumors;

 -  Patients with contraindication to treatment of endoscopy, surgery and TIPS: severe
 coagulation defects, allergic to contrast medium used in TIPS, hepatic encephalopathy,
 spontaneous bacterial peritonitis;

 -  Patients with conditions that will influence the accuracy of HVPG measurement:
 Cavernous transformation of portal vein, diffused portal vein thrombosis, severe
 shunt;

 -  Patients refuse to give consent to the study.