الفهرس 
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Abstract
Background :After an episde of acute esophageal variceal bleeding, legation (EVL) has replaced EIS as the endoscopic treatment of choice in the management of bleeding esophageal varices. On the other hand, (ISMN) Isosoribide 5- mononitrate has been shown to be the even more effective than propranolol alone in reduction of portal pressure and in the prevention of variceal rebleeding. Aims: The efficacy of endoscopic variceal ligation (EVL) versus ISMN with propranolol versus propranolol alone for prevention of variceal rebleeding. Methods:One hundred eighty one patients with a history of esophageal variceal rebleeding were randomized into three groups. Group I (EVL group, 61 patients) undergo regular endoscopic ligation until variceal obliteration, group II (propranolol + ISMN group, 60 patients) and group III (propranolol group, 60 patients) using drug therapy during the study period to prevent rebleeding. Results :After a median follow up period of 6-12 months, recurrent upper gastrointestinal bleeding developed in 17patients in group I, 25 patients in group II and 31 patients in group III. The actuarial probability of rebleeding from esophageal varcies was lowered in the EVL group. Treatment failure occurred in patients (17.7%) in group I, (28.3%) in group II and 20patients (33.3%) group III. Three patients in group I, three patients in group II and four patients in group III died. Complications occurred in 9 patients (15%) in group I, 11 patients (18.3%) in group II and 10 patients (16.8%) in group III. Conclusion: Our trail showed that legation was more effective than drug therapy with less complications, also combination therapy by propranolol and ISMN was better than propranolol alone in the prevention of varical rebleeding.