Comparative Study of Carvedilol Monotherapy Versus Combination Therapy With Endoscopic Variceal Ligation (EVL) for Primary Prophylaxis of Variceal Bleeding in Patients With Hepatocellular Carcinoma With High-Risk Esophageal Varices

Esophageal varices are common in patients with hepatocellular carcinoma (HCC), with an incidence rate of 63% at the time of HCC diagnosis. Following an acute variceal bleed, the 6-week mortality rate for HCC patients is as high as 26%. Mortality rates escalate notably in HCC patients experiencing acute variceal bleeding, especially with increasing cancer severity indicated by BLCL status. Research suggests that the cumulative incidence rate of variceal bleeding at one year in patients receiving primary prophylaxis is almost half that of patients not receiving any prophylaxis. Beta blockers are the standard therapy for primary prophylaxis in patients with portal hypertension to prevent variceal bleeding. Endoscopic band ligation has also shown promising results in recent studies. However, the combined impact of beta blockers and esophageal band ligation on lowering the incidence of variceal bleeding remains unstudied. The aim of this study is to compare the efficacy of carvedilol monotherapy versus combination therapy with carvedilol and endoscopic band ligation in patients with HCC for primary prophylaxis of high-risk esophageal varices.

Sex

All

Minimum age

18 Years

Maximum age

80 Years

Inclusion Criteria:

1. Age 18-80 years
2. Cirrhosis with HCC
3. High risk oesophageal varices (\*large or small with RCS)
4. Valid consent

Exclusion Criteria:

1. Any contra-indication to beta-blockers
2. Any EVL or Sclerotherapy within last 3 months
3. Any past history of TIPS or surgery for portal hypertension
4. HCC with BCLC-D
5. Patients with past history of variceal bleed.
6. Patient With Liver transplant expected in next 2 weeks would be excluded