Elective esophageal variceal ligation (EVL) is performed to decrease the risk of variceal hemorrhage. Side effects of EVL include hemorrhage, chest pain, dys phagia, and odynophagia. Because gastric acid may exacerbat...Elective esophageal variceal ligation (EVL) is performed to decrease the risk of variceal hemorrhage. Side effects of EVL include hemorrhage, chest pain, dys phagia, and odynophagia. Because gastric acid may exacerbate postbanding ulcers and delay healing, proton pump inhibition may decrease side effects associated w ith EVL. The aim of this study was to assess the efficacy of pantoprazole, a pro ton pump inhibitor, as an adjunct to elective EVL. We performed a double- blind ed, randomized, placebocontrolled trial of pantoprazole after elective EVL. Subj ects in the pantoprazole arm received 40 mg pantoprazole intravenously after EVL followed by 40 mg oral pantoprazole for 9 days. Control subjects received intra venous and oral placebo. Subjects underwent upper endoscopy 10 to 14 days after banding. Primary outcomes included the size and number of ulcers and the subject s’ reports of dysphagia, chest pain, and heartburn. Forty- four subjects were randomized: 42 completed the protocol. At follow- up endoscopy, the mean numbe r of ulcers was similar in the two groups. However, the ulcers in the pantoprazo le group were on average half as large as in the placebo group (37 mm2 vs. 82 mm 2, P < .01). Chest pain, dysphagia, and heartburn scores were not significantly different. Four subjects, all in the placebo group, had adverse outcomes, includ ing 3 who bled from postbanding ulcers and 1 with sepsis. In conclusion, subject s receiving pantoprazole after elective EVL had sigaificandy smaller postbanding ulcers on follow- up endoscopy than subjects receiving placebo. However, the t otal ulcer number and patient symptoms were not different between the groups.展开更多
文摘Elective esophageal variceal ligation (EVL) is performed to decrease the risk of variceal hemorrhage. Side effects of EVL include hemorrhage, chest pain, dys phagia, and odynophagia. Because gastric acid may exacerbate postbanding ulcers and delay healing, proton pump inhibition may decrease side effects associated w ith EVL. The aim of this study was to assess the efficacy of pantoprazole, a pro ton pump inhibitor, as an adjunct to elective EVL. We performed a double- blind ed, randomized, placebocontrolled trial of pantoprazole after elective EVL. Subj ects in the pantoprazole arm received 40 mg pantoprazole intravenously after EVL followed by 40 mg oral pantoprazole for 9 days. Control subjects received intra venous and oral placebo. Subjects underwent upper endoscopy 10 to 14 days after banding. Primary outcomes included the size and number of ulcers and the subject s’ reports of dysphagia, chest pain, and heartburn. Forty- four subjects were randomized: 42 completed the protocol. At follow- up endoscopy, the mean numbe r of ulcers was similar in the two groups. However, the ulcers in the pantoprazo le group were on average half as large as in the placebo group (37 mm2 vs. 82 mm 2, P < .01). Chest pain, dysphagia, and heartburn scores were not significantly different. Four subjects, all in the placebo group, had adverse outcomes, includ ing 3 who bled from postbanding ulcers and 1 with sepsis. In conclusion, subject s receiving pantoprazole after elective EVL had sigaificandy smaller postbanding ulcers on follow- up endoscopy than subjects receiving placebo. However, the t otal ulcer number and patient symptoms were not different between the groups.
