Comparison of Endoscopic Variceal Ligation (EVL) With Propranolol in Non Cirrhotic Portal Hypertension (NCPH)
Comparison of Endoscopic Variceal Ligation (EVL) With Propranolol in Non Cirrhotic Portal Hypertension (NCPH)
Background: Variceal bleeding is a major cause of morbidity and mortality in patients with
 Non Cirrhotic Portal Hypertension (NCPH). Beta blockers (BB) and endoscopic variceal ligation
 (EVL) have been used to prevent rebleeding in these patients, largely based on data from
 cirrhotic patients. Endotherapy in the form of EST has been well studied in preventing
 rebleed in patients with NCPH. Initial studies showed that EST significantly reduced the
 rebleeding rate in patients of NCPH. Data from these studies suggests a rebleed rate of
 approximately 25% at 2yr and 35% at 5 years.

 Beta blockers have been found to be quite effective in both primary as well as secondary
 prophylaxis of variceal bleeding in cirrhotic and are accepted mode of treatment. In contrast
 to liver cirrhosis, published data on the effect of beta blocker therapy on NCPH are scanty.
 Animal data and human data suggests that beta blockers reduce portal pressure in patients
 with NCPH. In two placebo controlled trials of propranolol on secondary prophylaxis of
 variceal bleeding in non cirrhotic patients. both studies demonstrated the efficacy of
 propranolol in decreasing rebleed rate. However, no comparisons hae been made with EVL till
 date.

 Hypothesis: The investigators hypothesis that In patients with NCPH, treatment with beta
 blockers will lead to reduction in portal pressure and decrease in portosystemic shunting
 leading to reduction in variceal rebleeding Aim of the study: Aim: To compare the efficacy
 and safety of Propranolol and EVL in the prevention of variceal rebleeding in patients with
 NCPH.
Inclusion Criteria:

 -  Patients with Non Cirrhotic Portal Hypertension (NCPH) presenting to our Liver
 Diseases Follow-up Clinic with history of hemetemesis and/or malena within the past 6
 weeks and proven to have esophageal varices as the bleeding source on upper GI
 endoscopy

 Exclusion Criteria:

 -  A history of surgery for portal hypertension

 -  Patients already on a EST, EVL, or glue injection program before presenting to our
 hospital

 -  Patients already on beta blockers for primary prophylaxis of variceal bleed

 -  Severe cardiopulmonary or renal disease

 -  Bradycardia (basal heart rate, <50 beats per minute [bpm]) or complete heart block

 -  A history of severe side effects or contraindications to β- blockers, like bronchial
 asthma, diabetes mellitus, heart failure, peripheral vascular disease, prostatic
 hypertrophy, or arterial hypotension (systolic blood pressure <90 mm Hg)

 -  Refusal to give informed written consent to participate in the trial

 -  Patients bleeding from gastric varices or Portal Hypertensive Gastropathy (PHG).

 -  Patients who had a failure of primary hemostasis during acute bleed were also
 excluded.