International guidelines recommend that primary prophylaxis of varices in patients with cirrhosis be either non-selective beta-blockers (NSBBs) or variceal band ligation (VBL). These recommendations are based on studies that include both compensated and decompensated patients. Notably, the European Association for the Study of the Liver 2018 guidelines recognise a gap in the efficacy of NSBB therapy for patients with decompensated cirrhosis.1 The Baveno guidelines recommend preventing further decompensation in patients with ascites and high-risk varices (large varices >5 mm, or with red spot signs, or Child-Pugh-Turcotte (CPT-C)), with traditional NSBBs or carvedilol preferred over VBL.2 The American Association for the Study of Liver Diseases guidelines support NSBBs or VBL for large high-risk varices.3 However, a recent systematic review with network meta-analysis indicated that VBL is associated with higher risks of complications and mortality compared with NSBBs.4 The supporting evidence for these recommendations is limited, and it remains unclear whether the same treatment options or combination therapies are more effective in decompensated cirrhosis (CPT B or C). In Gut , Tevethia et al report the results of the CAVARLY trial.5 The study compared carvedilol, VBL and a combination of both for preventing the first variceal bleed in patients with CPT- B/C cirrhosis (up to C-13) and high-risk oesophageal varices (>5 mm or <5 mm with red signs). The authors excluded patients with contraindications to carvedilol, hepatocellular carcinoma, portal vein thrombosis, platelet count <30 000 per µL, those on therapeutic anticoagulation, or with previous VBL or transjugular intrahepatic portosystemic shunt (TIPS). They enrolled 330 patients (110 for each arm) …

中文翻译：

---

Child-Pugh-Turcotte B 型和 C 型患者的高风险静脉曲张：考虑使用卡维地洛套扎术以预防首次静脉曲张出血，尤其是 MASLD 相关肝硬化患者


国际指南建议肝硬化患者静脉曲张的一级预防是非选择性β受体阻滞剂（NSBB）或静脉曲张套扎术（VBL）。这些建议基于包括代偿期和失代偿期患者的研究。值得注意的是，欧洲肝脏研究协会 2018 年指南认识到 NSBB 治疗对失代偿性肝硬化患者的疗效存在差距。1 Baveno 指南建议预防腹水和高危静脉曲张（大静脉曲张 >5）患者进一步失代偿。 mm，或有红斑征象，或 Child-Pugh-Turcotte (CPT-C)），传统 NSBB 或卡维地洛优于 VBL。2 美国肝病研究协会指南支持 NSBB 或 VBL 用于治疗大的高风险3 然而，最近的一项网络荟萃分析系统回顾表明，与 NSBB 相比，VBL 与更高的并发症和死亡风险相关。4 这些建议的支持证据有限，目前尚不清楚是否相同的治疗方案或联合疗法对于失代偿性肝硬化（CPT B 或 C）更有效。 Tevethia 等人在 Gut 报告了 CAVARLY 试验的结果。 5 该研究比较了卡维地洛、VBL 以及两者联合用药预防 CPT-B/C 肝硬化（高达 C-13）和高危患者首次静脉曲张出血的情况。 - 食管静脉曲张风险（>5 mm 或 <5 mm，有红色迹象）。作者排除了有卡维地洛禁忌证、肝细胞癌、门静脉血栓形成、血小板计数 <30 000/μL 的患者、接受治疗性抗凝治疗或既往接受过 VBL 或经颈静脉肝内门体分流术 (TIPS) 的患者。他们招募了 330 名患者（每组 110 名）……