Secondary Prophylaxis of Cirrhotic Gastric Variceal Bleeding: Addition of Non-Selective Beta-Blockers to Endoscopic Combined Treatment

Background: It remains unclear whether the addition of non-selective beta-blockers (NSBB) provides further benefit after combined use of tissue adhesive and endoscopic variceal ligation for bleeding gastroesophageal varices.

Objective: This is the first cohort study comparing the secondary prophylactic efficacy of adding NSBB to combined endoscopic treatment in cirrhotic patients with gastric varices (without inclusion of isolated gastric varices [IGVs], which are rare in patients with cirrhosis without splanchnic thrombosis).

Methods: We retrospectively analyzed two matched large cohorts of cirrhotic patients with gastric varices who received combined endoscopic treatment and were assigned to receive NSBB treatment or not as secondary prophylaxis. Further sub-analyses were performed. The 5-year overall survival and rebleeding rates were compared.

Results: A total of 490 patients were enrolled, 130 of whom took NSBB. After propensity score matching (PSM), both groups comprised 130 patients. No significant difference between the NSBB and non-NSBB groups was observed regarding 5-year survival (87.40% vs. 83.64%, HR 0.62, 95% CI 0.33-1.17), while NSBB decreased the 5-year rebleeding rate from 45.7% to 30.64% (HR 0.57, 95% CI 0.39-0.82). The same was true when comparing the 2 groups after PSM. NSBB (HR 0.54, 95% CI 0.37-0.79) and splenectomy (HR 0.65, 95% CI 0.44-0.96) independently reduced rebleeding but did not affect survival. In patients without splenectomy, NSBB treatment improved survival (HR 0.43, 95% CI 0.21-0.89) and reduced rebleeding (HR 0.52, 95% CI 0.34-0.78).

Conclusion: We show for the first time that adding NSBB to combined endoscopic therapy significantly reduced recurrent variceal bleeding in cirrhotic patients but did not improve overall survival, except for patients without splenectomy. The addition of NSBB for patients receiving combined endoscopic treatment of gastroesophageal varices provides benefits but does not prolong overall survival.