Prevention of a first episode of variceal bleeding: Role of duplex Dopplersonographic measurement of the acute response to beta-blockers

The aim of our study was to assess whether acute variations in portal vein Doppler sonographic parameters induced by administration of a single beta-b locker agent are predictive of the long-term effects of these drugs in the prevention of a first episode of variceal bleeding. In 30 patients with liv er cirrhosis at high risk for variceal bleeding, duplex cirrhosis at high r isk fnr variceal bleeding Doppler sonographic parameters (maximal portal fl ow velocity, portal blood flow, and congestion index) were measured before and 4 h after the administration of 40 mg of propranolol. twenty-three of t hese patients started chronic therapy with propanolol and were evaluated pe riodically (seven patients were excluded because they did not continue the therapy). The percentage of patients free from bleeding was 86.9% at the fi rst year and 77.8% at the second year. Among a series of clinical, laborato ry, and instrument-based parameters, the only one related to first bleeding , selected by the Cox regression model, was the percentage decrease in maxi mal por tal flow velocity observed after initial admnistration of propranol ol (P < 0.01). The best cutoff value for the percentage decrease in portal flow velocity (portal flow velocity test) was 12%. The prevalence of bleedi ng had been 25% (3 of 12) in patients with positive portal flow velocity te st results (12% decrease or more), versus 64% (7 of 11) in patients with ne gative portal flow velocity test results. The actuarial probability of rema ining free from bleeding (Kaplan-Meier analysis) was different in these two groups (log rank P < 0.01). The portal flow velocity test represents a saf e and feasible method to predict the efficacy of beta-blockers in the preve ntion of a first bleeding episode in patients with cirrhosis. In patients w ith negative results on the portal flow velocity test, an alternative thera peutic approach should be considered.