Reply to Evrard and colleagues

We would like to thank Drs. Evrard and colleagues for their comments on our article regarding the prevention of gastric variceal bleeding [1].

Evrard et al. have investigated the role of propranolol in the prevention of gastroesophageal variceal rebleeding [2]). Enrolled in their study were 41 patients with gastroesophageal variceal rebleeding, but only 10 of them were bleeding from gastric varices. Evrard et al. noted that propranolol was as effective as Histoacryl injection in the prevention of gastroesophageal variceal rebleeding, but propranolol was associated with fewer complications.

Owing to the small sample size, it is difficult to draw a definite conclusion that nonselective beta-blockers can be employed to prevent gastric variceal bleeding. The application of propranolol in the prevention of esophageal variceal rebleeding has been well established [3] [4]), but no controlled studies have ever been specifically focused on the prevention of rebleeding from gastric varices. Currently, nonselective beta-blockers appear to be promising; however, their role in the prevention of rebleeding from gastric varices awaits further investigation.

We agree that the inclusion of nonselective beta-blockers as a treatment modality could be helpful for clinicians when they are presented with patients with contraindications to cyanoacrylate injection and the transjugular intrahepatic portosystemic shunt.

References

• 1 Lo G H, Liang H L, Chen W C. et al . A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt vs. cyanoacrylate injection in the prevention of gastric variceal rebleeding.  Endoscopy. 2007;  39 679-685
• 2 Evrard S, Dumonceau J M, Delhaye M. et al . Endoscopic Histoacryl obliteration versus propranolol in the prevention of esophagogastric variceal rebleeding: a randomized trial.  Endoscopy. 2003;  35 729-735
• 3 Bernard B, Lebrec D, Mathurin P. et al . Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis.  J Hepatol. 1997;  26 312-324
• 4 Lo G H, Chen W C, Chen M H. et al . A prospective, randomized trial of endoscopic variceal ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding.  Gastroenterology. 2002;  123 728-734