Banding Ligation With Carvedilol Versus Carvedilol for the Prevention of First Bleeding
Banding Ligation With Carvedilol Versus Carvedilol for the Prevention of First Bleeding
Endoscopic variceal ligation (EVL) and carvedilol have been documented to be effective in
 prophylaxis of the first bleeding. The efficacy & safety of combining EVL and carvedilol in
 prophylaxis of the first bleeding is still unknown. This study aims to investigate the value
 of combination therapy.
Combination of EVL and β-blocker has been proven effective in the prevention of variceal
 rebleeding . However, Our previous study showed that combination of EVL and nadolol do not
 have enhanced effect in the prophylaxis of 1st variceal bleeding as compared with nadolol
 alone . One of the drawbacks of EVL is esophageal ulcer. On the other hand ,carvedilol, an
 anti-α beta-blocker, has been proven to be more effective than propranolol in the reduction
 of portal pressure. Carvedilol has been proven to be more effective than EVL in the
 prevention of 1st variceal bleeding. The investigators thus conduct a multicenter trial to
 evaluate whether combination of EVL and carvedilol could be more effective than carvedilol
 alone in the prophylaxis of 1st esophageal variceal bleeding . The goal of patients receiving
 EVL is to reduce variceal size, not variceal obliteration, in anticipation for fewer sessions
 required for each patient and fewer possibility of esophageal ulcer bleeding.
Inclusion Criteria:

 1. Cirrhosis with esophageal varices are larger than F2.

 2. No history of variceal bleeding.

 3. In three months have not implemented preventive esophageal variceal ligation. (4)age
 20yrs～75yrs.

 Exclusion Criteria:

 1. Association with HCC or other cancers .

 2. Refractory ascites.

 3. Jaundice, bilirubin > 5mg/dl.

 4. Encephalopathy.

 5. Cr.>3mg/dL.

 6. A-V,block bradycardia (PR < 60/mim).

 7. Hypotension systolic blood pressure<95/mmHg .

 8. Refusal to participate.

 9. Carvedilol allergy

 10. Second degree-third degree Atrio-ventricular block.

 11. Bradycardia.

 12. WPWsyndrome

 13. Hypotension

 14. Psychogenic shock.

 15. Asthma. All the patients are randomized based on a random number.