Hepatocellular Carcinoma Clinical Trial
Official title:
Endoscopic Treatment Versus Propranolol for 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.
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