Addition of Propranolol and Isosorbide Mononitrate to Endoscopic Variceal Ligation Does Not Reduce Variceal Rebleeding Incidence

EVL alone is sufficient to prevent variceal rebleeding in cirrhotic and noncirrhotic patients with history of variceal bleeding. Addition of propranolol and ISMN to EVL does not reduce the incidence of variceal rebleeding but increases severe adverse effects. Risk factors for rebleeding include ascites, low serum albumin, and high hepatic venous pressure gradients.