The goal of this clinical trial is to evaluate whether endoscopic variceal ligation (EVL) or carvedilol is more effective at preventing the first esophageal variceal bleeding (EVB) in patients with hepatocellular carcinoma (HCC). It will also learn about the safety of EVL and carvedilol in patients with HCC. The main questions it aims to answer are:
Whether EVL or carvedilol is more effective at preventing initial EVB in patients with HCC with high-risk EVs.
What medical problems do participants have when undergoing EVL or taking carvedilol? Researchers will compare the efficacy and safety of EVL to carvedilol for the prevention of first EVB in patients with HCC.
Participants will:
Undergo EVL every 3-4 weeks until variceal eradication and then receive regular endoscopic follow-up according to the protocol, or Take carvedilol every day (start from 6.25 mg/d and then titrate to 12.5 mg/d if tolerable).
Visit the clinic once every 2-3 months for checkups and tests. Keep a diary of their vital signs (SBP, DBP, and HR) as well as symptoms.
None
Age less than 20 years or greater than 90 years.
History of esophageal variceal bleeding.
Previous treatment for EVs, including EVL, endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), or surgical interventions.
Use of non-selective β-blockers within two weeks prior to enrollment.
Parallel
Endoscopic variceal ligation
Procedure/SurgeryEVL will be performed and repeated every 3 to 4 weeks until the EVs are eradicated. Following this, patients will undergo regular upper gastrointestinal endoscopic surveillance, initially every three months for a total of two sessions, then every six months for a total of two sessions, and subsequently annually. If EVs are found to recur during surveillance, additional EVL will be performed every 3 to 4 weeks until the varices are again eradicated endoscopically.
Carvedilol
DrugThe initial dosage of carvedilol is set at 6.25 mg daily. In the absence of hypotension (systolic blood pressure \< 90 mmHg), bradycardia (resting heart rate \< 55 beats per minute), or other adverse effects, hospitalized patients may have their dosage increased to 12.5 mg daily after 3 days, while outpatient patients may increase their dosage to 12.5 mg daily after 7 days. This dosage represents the target dose for the trial.
Esophageal variceal bleeding
The cumulative incidence of esophageal variceal bleeding
Other upper gastrointestinal bleeding
The cumulative incidence of other upper gastrointestinal bleeding
First/further nonbleeding liver decompensation
Events that defined first/further nonbleeding liver decompensation were based on the Baveno VII consensus
Overall survival
Adverse events
Primary and secondary outcomes categorized by BCLC staging in the subgroup analysis
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