Primary Prevention of Patients With Hepatocellular Carcinoma and Concomitant Esophageal Varices
Primary Prevention of Patients With Hepatocellular Carcinoma and Concomitant Esophageal Varices
Randomized comparison within the endoscopic esophageal varices ligation versus non-selective
 beta-blocker in the primary prevention of esophageal variceal bleeding in patients with HCC.
Gastroesophageal variceal bleeding is a major complication of cirrhosis and has high rate of
 rebleeding and mortality. In these 20 to 30 years, medical advances have significantly
 improved the prognosis of variceal bleeding. Nevertheless, the mortality of gastroesophageal
 variceal bleeding is still nearly 20 to 30%.

 Hepatocellular carcinoma (HCC) is one of the most common malignancy in Asian, and is also the
 special group in portal hypertension. Studies in Italy, more than 50% of patients diagnosed
 with HCC are concomitant with esophageal varices. HCC and portal thrombosis caused by HCC
 itself are all independent risk factors of gastroesophageal bleeding. Once the bleeding,
 rebleeding rate is up to 50% even if early use of vasoconstrictor agents and endoscopic
 therapy, which is generally 2 times in patients with cirrhosis.

 According to 2010 Baveno V recommendations, non-selective beta-blockers (NSBB) or endoscopic
 variceal ligation (EVL) are first choice for primary prevention of first variceal bleeding in
 cirrhotic patients. However, risk factors of variceal bleeding caused by HCC or cirrhosis are
 different, and portal hypertension is particularly high in patients with HCC and may be
 combined with portal vein thrombosis. NSBB sufficient to decreased portal hypertension to
 prevent variceal bleeding is not clear. In Hepatology 2010, Lebrec claimed that NSBB used for
 cirrhotic patients with refractory ascites had poor prognosis, the main cause of death were
 the progression of HCC and sepsis, although the impact of NSBB for HCC patients are not
 entirely clear, but this issue remind clinicians to careful use of NSBB in these patients.
 Since NSBB possible adverse effects, the use of EVL to prevent bleeding in patents with HCC
 is superior to NSBB? These need further study to clarify. So we designed this study to
 evaluate the feasibility and effectiveness of using EVL or NSBB to prevent first bleeding in
 patients with HCC concomitant with esophageal varices.
Inclusion Criteria:

 -  Between 20 and 80 years old

 -  Hepatocellular carcinoma (HCC) associated with esophageal varices

 -  F2 or F3 esophageal varices (Beppu et al classification)

 -  Hepatocellular carcinoma (HCC) associated with portal thrombosis

 Exclusion Criteria:

 -  History of esophageal variceal bleeding

 -  Had received endoscopic variceal ligation (EVL) or endoscopic injection sclerotherapy
 (EIS)

 -  Pregnancy, or the patients with other terminal illness (such as other terminal
 cancers, heart failure, renal failure...)

 -  Propranolol contraindications (such as atrioventricular block, heart failure, chronic
 obstructive pulmonary disease, asthma, poorly controlled diabetes, severe peripheral
 arterial disease...)