Endoscopic Variceal Ligation and Nadolol to Prevent Variceal Rebleeding

Abstract This chapter investigates combining endoscopic variceal ligation (EVL) and nadolol for secondary prophylaxis of variceal rebleeding in cirrhotic patients. The underlying randomized controlled trial, which researchers conducted across four Spanish hospitals, compared the effectiveness of EVL alone with EVL plus the beta blocker nadolol in preventing rebleeding in patients with bleeding esophageal varices. The study showed that the combined therapy group experienced a significant reduction in rebleeding rates (14% vs. 38%), although it did not show any mortality benefit. Combination therapy also led to higher adverse effects and treatment failure in some cases. Finally, the chapter emphasizes the importance of clinical follow-up to manage side effects and optimize treatment in patients using this combined approach.