Carvedilol versus variceal band ligation in primary prevention of variceal bleeding in liver cirrhosis (CALIBRE)

A large UK trial has now finished recruiting 2,630 patients with liver cirrhosis to determine whether the drug carvedilol is better than a routine endoscopic procedure at preventing their first variceal bleed. Bleeding from swollen veins in the oesophagus is a life-threatening complication of cirrhosis. Both carvedilol (a beta-blocker that lowers pressure in these veins) and variceal band ligation (where a doctor places rubber bands around the veins during an endoscopy) are currently recommended for prevention, but doctors do not know which works best. The CALIBRE trial directly compares the two in a head-to-head randomised study across multiple NHS hospitals. If carvedilol proves superior or non-inferior to band ligation, it could shift clinical practice toward a simpler, drug-based approach that avoids repeated endoscopic procedures. This would reduce patient discomfort, free up endoscopy appointments, and lower NHS costs. The trial also includes a health economic evaluation, so funders will have clear data on cost-effectiveness. Results are expected to inform updated UK guidelines on managing varices in cirrhosis.