Comparison of Symptoms and Risk of Rebleeding in Patients Receiving PPI With Sucralfate vs PPI Alone After Endoscopic Variceal Band Ligation

Abstract

Background: Endoscopic variceal band ligation (EVBL) is an established therapy for esophageal variceal hemorrhage but is frequently associated with post-procedural complications including esophageal ulceration, dysphagia, retrosternal pain, and rebleeding. While proton pump inhibitors (PPIs) are commonly administered post-EVBL to promote ulcer healing, residual symptom burden and rebleeding risk remain, and the potential additive benefit of sucralfate as a mucosal protectant is uncertain. Objective: To compare symptoms and risk of rebleeding in patients receiving PPI with sucralfate versus PPI alone following EVBL. Methods: A randomized controlled trial was conducted at a tertiary care hospital over six months. Seventy-two patients undergoing EVBL were randomized 1:1 to receive PPI plus sucralfate or PPI alone. Patients were followed for two weeks for assessment of post-ligation symptoms, endoscopic ulcer occurrence, and rebleeding. Statistical analyses included independent sample t-tests and chi-square tests, with logistic regression used to adjust for confounders. Results: The PPI plus sucralfate group experienced significantly lower rates of retrosternal pain (13.9% vs 36.1%, p=0.037), dysphagia (8.3% vs 27.8%, p=0.041), ulcer formation (16.7% vs 41.7%, p=0.018), and rebleeding (5.6% vs 22.2%, p=0.042) compared to PPI alone. Conclusion: Adjunctive sucralfate significantly improves post-EVBL symptom control, reduces ulcer formation, and lowers rebleeding risk, supporting its use in routine post-ligation management.