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- W2958016629 abstract "Potential conflict of interest: Nothing to report. We thank Gin‐Ho Lo for taking interest in our study and for the comments.1 Dr. Lo raises important points comparing the different adverse effect profiles of nonselective beta‐blockers (NSBBs) and variceal band ligation (VBL). Current guidelines still recommend the use of either NSBBs or VBL for the primary prevention of esophageal variceal bleeding, and the debate is likely to continue.2 In our systematic review and network meta‐analysis, when compared with VBL, NSBBs were associated with a higher rate of overall adverse events, resulting in treatment discontinuation. On the other hand, VBL was associated with 3 times greater number of serious adverse events.1 Therefore, NSBBs still represent a less invasive prophylactic measure with additional benefits beyond prevention of variceal bleeding in patients with cirrhosis. As opposed to VBL, NSBBs reduce portal pressure, as demonstrated by hepatic venous pressure gradient (HVPG) assessment. The hemodynamic effects of NSBBs are likely responsible for the additional survival benefit observed in our meta‐analysis and previous studies.3 A recently published randomized controlled trial showed that NSBBs also reduce the incidence of ascites and may increase decompensation‐free survival.4 Unfortunately, some patients do not adequately respond to NSBBs, and routine HVPG assessment is invasive and not feasible in clinical practice. However, a recent study has suggested that splenic stiffness, measured noninvasively through acoustic radiation force impulse assess elastography, may be beneficial in predicting the hemodynamic response to carvedilol therapy as primary prophylaxis in patients with cirrhosis and high‐risk esophageal varices.5 We agree that the choice of therapy should still be a decision made jointly by the patient and the medical team. However, not only the risk of adverse effects needs to be discussed with the patient but also the potential additional benefits of NSBBs, including decreased incidence of ascites and mortality." @default.
- W2958016629 created "2019-07-23" @default.
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- W2958016629 date "2019-10-29" @default.
- W2958016629 modified "2023-09-26" @default.
- W2958016629 title "Reply" @default.
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- W2958016629 doi "https://doi.org/10.1002/hep.30855" @default.
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