Gong DF, Cheng L. Therapeutic outcomes and predictors of efficacy for endoscopic variceal ligation plus propranolol in liver cirrhosis-related upper gastrointestinal bleeding. World J Gastrointest Surg 2025; 17(9): 109152 [DOI: 10.4240/wjgs.v17.i9.109152]
Corresponding Author of This Article
Long Cheng, Chief Physician, Department of Gastroenterology, Changde First People's Hospital, No. 818 Renmin Road, Changde 415000, Hunan Province, China. cdchenglong2024@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 109152 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.109152
Therapeutic outcomes and predictors of efficacy for endoscopic variceal ligation plus propranolol in liver cirrhosis-related upper gastrointestinal bleeding
Dan-Feng Gong, Long Cheng
Dan-Feng Gong, Long Cheng, Department of Gastroenterology, Changde First People's Hospital, Changde 415000, Hunan Province, China
Author contributions: Gong DF and Cheng L contributed to conception, design, data analysis, and manuscript drafting and editing; Gong DF and Cheng L contributed to collection, assembly of data and revised the manuscript; Gong DF and Cheng L contributed to conception, resources, and manuscript review and editing; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Changde First People's Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Long Cheng, Chief Physician, Department of Gastroenterology, Changde First People's Hospital, No. 818 Renmin Road, Changde 415000, Hunan Province, China. cdchenglong2024@163.com
Received: June 24, 2025 Revised: July 25, 2025 Accepted: August 4, 2025 Published online: September 27, 2025 Processing time: 92 Days and 1.6 Hours
Abstract
BACKGROUND
Cirrhosis-related upper gastrointestinal bleeding (UGIB) poses a fatal risk, and endoscopic ligation as a sole intervention shows inadequate effectiveness.
AIM
To evaluate the therapeutic efficacy of endoscopic variceal ligation (EVL) plus propranolol vs EVL monotherapy in patients with cirrhosis complicated with acute UGIB and identify predictors for clinical outcomes.
METHODS
This study enrolled 99 consecutive patients with cirrhosis presenting with acute UGIB between January 2024 and January 2025. Participants were allocated to either the control group (n = 49) receiving EVL alone or (2) the research group (n = 50) receiving EVL plus propranolol. Primary outcomes included treatment efficacy, venous blood flow [portal venous flow (PVF)/splenic venous flow (SVF)], and postoperative outcomes (hemostasis time, length of hospital stay, and rebleeding rates). Univariate and multivariate regression analyses were conducted to determine independent predictors of treatment response.
RESULTS
Compared with the control group, the research group demonstrated significantly better outcomes, including higher overall treatment efficacy, greater reductions in PVF and SVF, shorter hemostasis time and hospital stay, and lower rebleeding rates. Univariate analysis demonstrated significant associations between treatment efficacy and age, cirrhosis duration, Child-Pugh grade, bleeding duration, and treatment approach in patients with cirrhosis complicated with acute UGIB. Multivariate logistic regression identified three independent risk factors for poor outcomes, namely, advanced age (> 55 years), prolonged cirrhosis duration (≥ 4 years), and delayed bleeding intervention (> 24 hours).
CONCLUSION
The EVL plus propranolol regimen demonstrates significant efficacy in treating UGIB in cirrhosis, outperforming EVL alone in improving hemodynamics (PVF/SVF), shortening hemostasis and hospitalization duration, and reducing rebleeding rates. Moreover, advanced age, prolonged disease duration, and longer bleeding times are independent risk factors for poor therapeutic outcomes.
Core Tip: To date, few studies have analyzed the therapeutic effects and influencing factors of endoscopic variceal ligation (EVL) plus propranolol for cirrhotic upper gastrointestinal bleeding (UGIB). This study enrolled 99 patients with cirrhosis complicated with UGIB, comparing the intervention effects between EVL plus propranolol and EVL alone. Consequently, the combined therapy achieved markedly better efficacy, with outstanding hemostasis, ameliorated hemodynamic conditions, facilitated postoperative recovery, and featured a notably lower rebleeding rate.
