Carvedilol Combined with Endoscopy vs. Endoscopy for Prevention of Esophagogastric Varices Rebleeding in Cirrhotic Patients with Different Severity of Esophagogastric Varices

Purpose: This study aimed to assess the efficacy of endoscopic treatment alone compared to the combination of carvedilol with endoscopic treatment in preventing rebleeding of esophagogastric varices of varying severity in patients with hepatic cirrhosis. Methods: The study included 867 patients with hepatic cirrhosis and esophagogastric varices, who were admitted to Nanjing Drum Tower Hospital between July 2018 and December 2022. A 180-day follow-up period was implemented to evaluate the association between the combined use of carvedilol and endoscopy and clinical outcomes, focusing on esophagogastric variceal rebleeding and all-cause mortality. Propensity score matching (PSM) was performed on initially enrolled patients meeting the inclusion criteria (n = 232), resulting in the selection of 105 patients each in the endoscopy group and the combined carvedilol and endoscopy group. Subgroup analyses based on the severity of esophagogastric varices were conducted to compare the efficacy of the two treatment modalities. Results: After PSM, the endoscopy group and the combined carvedilol and endoscopy group exhibited a significant difference in rebleeding rates (29.52% vs. 14.29%, p = 0.006) and no significant difference in all-cause mortality (6.67% vs. 1.90%, p = 0.085). Multivariate Cox regression analysis revealed that the severity of esophagogastric varices was an independent risk factor influencing rebleeding ( chi 2 = 3.993, p = 0.046, hazard ratios (HR) = 2.85, 95% confidence intervals (CI): 1.02-7.95), while carvedilol emerged as an independent protective factor against rebleeding ( chi 2 = 6.222, p = 0.013, HR = 0.46, 95% CI: 0.25-0.85). Subgroup analysis based on the severity of esophagogastric varices showed that among patients with severe esophagogastric varices, the endoscopy group and the combined carvedilol and endoscopy group exhibited significant differences in rebleeding rates (34.12% vs. 16.25%, p = 0.009) and no significant differences in all-cause mortality (7.06% vs. 1.25%, p = 0.063). Among patients with non-severe esophagogastric varices, the endoscopy group and the combined carvedilol and endoscopy group showed no significant differences in rebleeding rates (10.00% vs. 8.00%, p = 0.684) and all-cause mortality (5.00% vs. 4.00%, p = 0.860). Conclusion: Combining carvedilol with endoscopy is more effective than endoscopy alone in preventing rebleeding from esophagogastric varices, though it does not impact patient survival. In patients with non-severe esophagogastric varices, the incorporation of carvedilol alongside endoscopy does not yield significant benefits in rebleeding or survival compared to endoscopy alone. Conversely, for patients with severe esophagogastric varices, the combined use of carvedilol and endoscopy demonstrates greater efficacy in preventing rebleeding than endoscopy alone, yet it does not influence all-cause mortality. Clinical Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IPR-17012836.