Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding

Bleeding from esophageal varices is associated with mortality rates ranging from 30 to 70 percent. 1 , 2 Many therapies have been evaluated for primary prophylaxis against bleeding in people with cirrhosis and large varices. 3 – 5 The most effective therapy is the use of nonselective beta-blockers, which reduce the incidence of a first bleeding episode and, to some extent, reduce bleeding-related mortality. 5 , 6 However, beta-blockers have unpredictable effects on the hepatic venous pressure gradient, which is used to assess their efficacy. 7 , 8 Measurement of this gradient requires an invasive technique in which a catheter is passed through the femoral or jugular vein . . .