A Trial of Ligation Plus Nadolol Versus Nadolol Alone in the Prophylaxis of First Variceal Bleeding in Cirrhosis

Inclusion Criteria: 1. the cause of portal hypertension was cirrhosis 2. the degree of esophageal varices was F2 (moderate varices) or more, associated with any of red color signs (red wale markings, cherry red spots or hematocystic spots) 3. no history of hemorrhage from esophageal varices 4. no current treatment with beta-blockers 5. cirrhosis was based on results of liver biopsy, or clinical and biochemical examinations and image studies Exclusion Criteria: 1. age greater than 75 years old or younger than 20 years old 2. association with malignancy, uremia or other serious medical illness which may reduce the life expectancy 3. presence of refractory ascites, hepatic encephalopathy or marked jaundice (serum bilirubin \> 10 mg/dl) 4. history of shunt operation, transjugular intrahepatic portosystemic stent shunt or endoscopic therapy (EIS or EVL) 5. had contraindications to beta-blockers, such as asthma, heart failure, complete atrioventricular block, hypotension ( systolic blood pressure \< 90 mmHg), pulse rate \< 60/ min 6. unable to cooperate