Evidence map›Paper›PMID 40288803›Full record

ArticleBMJ open2025

Endoscopic variceal ligation combined with carvedilol versus endoscopic variceal ligation combined with propranolol for the treatment of oesophageal variceal bleeding in cirrhosis: study protocol for a multicentre, randomised controlled trial.

Yiling Li, Li Du, Shuairan Zhang, Chuan Liu, Chao Ma, Xiaochao Liu, Huanhai Xu, Zhixu Fan, Shengjuan Hu, Jing Wang and 54 more

Abstract readClinical Trial Protocol
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

64 authors.

Yiling Li *Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning, China.ORCID http://orcid.org/0000-0003-3209-8105
Li Du *Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Shuairan Zhang *Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
Chuan Liu *Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing, Jiangsu, China.
Chao Ma *Department of Gastroenterology, Fuyang Second People's Hospital, Fuyang, Anhui, China.
Xiaochao Liu *Department of Gastroenterology, Hanzhong Central Hospity, Hanzhong, China.
Huanhai XuDepartment of Gastroenterology, Affiliated Yueqing Hospital of Wenzhou Medical University, Yueqing, China.
Zhixu FanDepartment of Gastroscope, The Sixth People's Hospital of Dandong, Dandong, Liaoning, China.
Shengjuan HuDepartment of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People's Hospital of Autonomous Region), Yinchuan, China.
Jing WangDepartment of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China.
Lichun ShaoDepartment of Gastroenterology, Air Force Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Lijun PengDepartment of Gastroenterology, Peking University People's Hospital Qingdao, Qingdao, Shandong, China.
Huiling XiangDepartment of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China.
Xuan LiangThe Fifth People's Hospital of Shenyang, Shenyang, China.
Wenhui ZhangDepartment of Gastroenterology, Daxing district people's hospital, Beijing, China.
Hongyun ZhaoDepartment of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Pengyuan HeDepartment of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China.
Jingyi XuHebei Key Laboratory for Liver Cirrhosis and Portal Hypertension, Xingtai People's Hospital, Xingtai, Hebei, China.
Qianlong LiDepartment of Gastroenterology, Suining Central Hospital, Suining, China.
Ling YangDivision of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yunhai WuThe Sixth People's Hospital of Shenyang, Shenyang, Liaoning, China.
Liyao ZhangThe Sixth People's Hospital of Shenyang, Shenyang, Liaoning, China.
Dianliang FangDepartment of Gastroenterology, The Fourth People's Hospital of Chongqing, Chongqing, China.
Hua YeDepartment of Gastroenterology, The Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, China.
Liwei ZhangDepartment of Gastroenterology, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, China.
Li ZhangDepartment of Intensive Care Medicine, Hepatology Second Hospital of Hohhot, Hohhot, Inner Mongolia, China.
Xiaojie ZhangDepartment of Gastroenterology, Yuci People's Hospital, Jinzhong, Shanxi, China.
Zhi WeiDepartment of Gastroenterology, Shandong Second Provincial General Hospital, Jinan, Shandong, China.
Ya PengDepartment of Gastroenterology, Hunan Provincial People's Hospital and the Affiliated Hunan Normal University, Changsha, China.ORCID http://orcid.org/0009-0002-3813-0217
Qinghua PanDepartment of Medical Oncology, Ganzhou Cancer Hospital, Ganzhou, China.
Quanke LiDepartment of Gastroenterology, Anqiu People's Hospital, Weifang, Shandong, China.
Jing XuDepartment of Infection, Lixin County People's Hospital, Bozhou, Anhui, China.
Dongli XiaDepartment of Gastroenterology, Fuling Hospital affiliated to Chongqing University, Chongqing, China.
Yuchen LvMedical Department, Qingdao Third People's Hospital, Qingdao, Shandong, China.
Zongchao ZhangDepartment of Hepatology, The Fifth Hospital of Xingtai, Xingtai, Hebei, China.
Chaoguang YanDepartment of Gastroenterology, Second People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
Jian WangDepartment of Gastroenterology, Shandong Healthcare Group Zibo Hospital, Zibo, Shandong, China.
Yuxia WanDepartment of Endoscopy, Qianwei People's Hospital, Leshan, Sichuan, China.
Biao XieDepartment of Gastroenterology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Haiming FangDepartment of Gastroenterology, Pingshan Hospital of Southern Medical University, Shenzhen, China.ORCID http://orcid.org/0000-0001-7436-7858
Wenlong YangDepartment of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Wei YanDivision of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yi ChenDepartment of Ultrasonography, The Sixth People's Hospital of Dandong, Dandong, China.
Shaoting ZhangSensetime Research, Shanghai, China.
Xiangman ZhangSuzhou Hengrui Medical Devices Co., Ltd, Suzhou, China.
Wei RaoShenzhen New Industries Biomedical Engineering Co Ltd, Shenzhen, Guangdong, China.
Xiurong XiaEmergency Department, The Affiliated Qingdao Third People's Hospital of Qingdao University, Qingdao, China.
Qiang QiaoDepartment of Gastroenterology, Ansteel Group General Hospital, Anshan, China.
Ruimiao YuDepartment of Gastroenterology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China.
Changzhen RenDepartment of Infectious Diseases, Zibo Central Hospital, Zibo, Shandong, China.
Ying SongDepartment of Gastroenterology, Xi'an Gaoxin Hospital, Xi'an, China.
Yuejun Yang48. Department of Gastroenterology, GongRen Hospital of WuZhou, Wuzhou, Guangxi, China.
Jianzhou LiDepartment of Gastroenterology, Xining Second People's Hospital, Qinghai, China.
Lei WangAnkang Traditional Chinese Medicine Hospital, Ankang, Shaanxi, China.
Zhenzhen ZhaiDepartment of Gastroenterology, Qilu Hospital of Shandong University Dezhou Hospital, Nanjing, Jiangsu, China.
Xuejin LiuDepartment of Gastroenterology, Zhoukou Central Hospital, Zhoukou, China.
Xingjun LuDepartment of Gastroenterology, The Peoples' Hospital of Bozhou, Bozhou, China.
Meng LiDepartment of Gastroenterology, Tongling Hospital of Traditional Chinese Medicine, Tongling, China.
Yansheng JiaDepartment of Endoscopy, The Fifth Hospital of Shijiazhuang, Shijiazbuang, Hebei, China.
Rong WangDepartment of Gastroenterology, Shanxi Provincial People's Hospital, Taiyuan, China.
Duolao WangDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK.ORCID http://orcid.org/0000-0003-2788-2464
Andres CardenasInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Zhendong JinDepartment of Gastroenterology, Changhai Hospital, Shanghai, China qixiaolong@vip.163.com zhendongjin@163.com.
Xiaolong QiLiver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing, Jiangsu, China qixiaolong@vip.163.com zhendongjin@163.com.ORCID http://orcid.org/0000-0002-3559-5855

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionLiver cirrhosis and its severe complication, oesophageal variceal bleeding (EVB), pose significant health risks. Standard treatment for EVB combines non-selective beta-blockers (NSBB) with endoscopic variceal ligation (EVL). Carvedilol, an NSBB with additional benefits, is preferred for compensated cirrhosis. However, no randomised controlled trial (RCT) has compared carvedilol with propranolol, a conventional NSBB, in combination with EVL for secondary prophylaxis. This study aims to compare the effectiveness and safety of these treatments in preventing variceal rebleeding or death in patients with cirrhosis and EVB. METHODS AND ANALYSIS: This multicentre, RCT is scheduled to begin in December 2024, with recruitment and follow-up continuing until December 2026. Eligible participants are patients with liver cirrhosis and EVB. Participants are randomly assigned in a 1:1 ratio to receive EVL combined with either carvedilol or propranolol. The primary endpoint is the incidence of variceal rebleeding or all-cause death. Secondary endpoints include all-cause death, liver-related death, each of the complications of portal hypertension (overt ascites, overt hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, portal vein thrombosis), hepatocellular carcinoma, changes in liver function (assessed by Child-Pugh and Model for End-Stage Liver Disease scores), changes in liver stiffness, changes in spleen stiffness, and adverse events. Subgroup and sensitivity analyses will be conducted to evaluate the consistency and robustness of the treatment effects. A total sample size of 524 patients (262 per group) is required to detect a significant difference between the treatment arms. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethics committee of the First Hospital of China Medical University (No. 2024-656-2). The study will follow the Declaration of Helsinki and Good Clinical Practice guidelines. The findings of this trial will be disseminated through peer-reviewed publications, conference presentations and healthcare professionals to guide future clinical practice. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (Registration number: ChiCTR2400089692).

Indexed as

Adrenergic beta-AntagonistsCarvedilolEsophageal and Gastric VaricesGastrointestinal HemorrhageLiver CirrhosisPropranololCombined Modality TherapyFemaleHumansLigationMaleMiddle AgedMulticenter Studies as TopicRandomized Controlled Trials as TopicAdrenergic beta-AntagonistsCarvedilolPropranololHepatobiliary diseaseOesophageal diseaseRandomized Controlled Trial

Identifiers

PMID40288803
PMCPMC12035452

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.