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Endoscopic Variceal Band LigationPhase 3NCT07608536

Comparison of Rabeprazole and Vonoprazan in the Prevention of Post-endoscopic Variceal Ligation Ulcer in Patients With Cirrhosis

A Phase 3 study testing Vonoprazan and Rabeprazol in people with Endoscopic Variceal Band Ligation, run by King George's Medical University at 1 site in India.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The study aims to to evaluate Vonoprazan effectiveness in prevention of post endoscopic variceal ligation (EVL) ulcer and its related bleed in comparison to Rabeprazole. All patients who are eligible for the study will be screened from outpatient department and endoscopy lab. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Endoscopic Variceal Band Ligation
What is being tested?
Vonoprazan and Rabeprazol
Could I receive a placebo?
No, everyone receives an active treatment
How many people
300 participants
Where
1 siteIndia
Study dates
1 May 2026to 31 Jul 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 years and above
  • Diagnosis of portal hypertension and esophageal varix should be established by endoscopy.
  • Who are willing to participate in the study

Who cannot join

  • Negative consent
  • Diagnosed with HCC
  • Already taking PPI/Vonoprazan for other indications
  • Using anticoagulants and antiplatelets

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Dr Sumit Rungta, DM- Medical Gastroenterology contact

+919935537944

drsumitrungta79@gmail.com

Dr Sayan Malakar, DM- Medical Gastroenterology contact

+919007057890

oneandonludrsayan@gmail.com

India1 site
  • King George Medical University

    Lucknow, Uttar Pradesh, 226003

    Dr Sumit Rungta, DM-Medical Gastroenterology, +919935537944, drsumitrungta79@gmail.com

    Dr Sayan Malakar, DM-Medical Gastroenterology, +919007057890, oneandonlydrsayan@gmail.com

Other trials in India

About this study

The study aims to to evaluate Vonoprazan effectiveness in prevention of post endoscopic variceal ligation (EVL) ulcer and its related bleed in comparison to Rabeprazole.

All patients who are eligible for the study will be screened from outpatient department and endoscopy lab. Patients who are diagnosed to have oesophageal varices and requiring EVL will be enrolled after fulfilling inclusion and exclusion criteria.

Read more

Patient clinical and demographic data will be collected in proforma. Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. One arm is Vonoprazan 20 mg once a day group and second arm will be rabeprazole 20 mg once a day. Duration of therapy will be 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care.

Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Read the detailed description

Bleeding from esophageal varices is a serious consequence of portal hypertension, and endoscopic variceal ligation (band ligation) is a mainstay of treatment. After the bands are applied, shallow mucosal ulcers predictably develop at the band sites and usually heal over roughly three weeks; occasionally, however, these healing ulcers bleed and contribute to illness and death. One proposed driver of delayed healing and bleeding is the exposure of these ulcers to stomach acid, which has led clinicians to use acid-lowering medicines-most often proton pump inhibitors-after the procedure, though the evidence that this helps remains inconsistent.

Vonoprazan belongs to a newer class of acid-suppressing agents (potassium-competitive acid blockers) that act on the gastric proton pump quickly, reversibly, and durably, overcoming several shortcomings of conventional proton pump inhibitors. Its value in lowering the burden of ulcers that form after band ligation has barely been examined.

This investigator-initiated trial will compare vonoprazan with rabeprazole, a standard proton pump inhibitor, in adults with cirrhosis and portal hypertension who are undergoing band ligation of esophageal varices. Three hundred eligible, consenting participants will be allocated in equal numbers to either vonoprazan 20 mg once daily or rabeprazole 20 mg once daily, each given for two weeks alongside standard beta-blocker therapy. The follow-up endoscopy at two weeks will be recorded, and the ulcers will be measured and graded by an endoscopist. The chief measure of interest is the size of the largest band-site ulcer (in millimetres) seen on the two-week surveillance endoscopy. Additional measures include the number of ulcers per patient, the grade of any bleeding ulcers, episodes of post-procedure bleeding through four weeks, swallowing-related symptoms such as pain and difficulty swallowing, and the occurrence of side effects including spontaneous bacterial peritonitis. The work will be carried out over eight months at a single tertiary-care gastroenterology unit in Lucknow, India.

Being tested
Vonoprazan, Rabeprazol
Keywords
Post endoscopic variceal ligation (EVL) ulcer, Vonoprazan, Rabeprazole
Medical subject headings
Ulcer

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • VonoprazanDrug

    Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. One arm is Vonoprazan 20 mg once a day group and second arm will be rabeprazole 20 mg once a day. Duration of therapy will be 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care.

    Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

  • RabeprazolDrug

    Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. One arm is Vonoprazan 20 mg once a day group and second arm will be rabeprazole 20 mg once a day. Duration of therapy will be 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care.

    Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Study groups in NCT07608536
Study groupRoleWhat they receive
Role of Vonoprazan in prevention of post EVL ulcerExperimentalPatients who are diagnosed to have esophageal varices and requiring EVL will be enrolled Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. The experimental arm will receive Vonoprazan 20 mg once a day for 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.
Receives: Drug: Vonoprazan
Role of Rabeprazole in prevention of post EVL ulcerActive comparatorPatients who are diagnosed to have esophageal varices and requiring EVL will be enrolled Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. The comparator arm will receive Rabeprazole 20 mg once a day for 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.
Receives: Drug: Rabeprazol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. To compare the maximum post-EVL esophageal ulcer diameter (mm) at 2 weeks (Day 14), measured on surveillance upper GI endoscopy, between the Vonoprazan and Rabeprazole groups.

    Measured: Two weeks

  2. To compare the number of post-EVL ulcers per participant at Day 14, and the severity of any bleeding ulcers (graded by the Jamwal & Sarin classification), between the Vonoprazan and Rabeprazole groups

    Measured: Two weeks

Secondary outcomes (1)
  1. To compare the incidence of adverse effects in Vonoprazan and Rabeprazole groups

    Measured: Two weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 May 2026
  2. Study start1 May 2026 (estimated)
  3. Primary completion31 Jul 2026 (estimated)
  4. Study completion31 Jul 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel group randomized controlled trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
300 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07608536
Sponsor's protocol ID
2355/Ethics/2026
Status last verified
May 2026
First submitted
8 Apr 2026
Last updated
27 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Jamwal KD, Maiwall R, Sharma MK, Kumar G, Sarin SK. Case Control Study of Post-endoscopic Variceal Ligation Bleeding Ulcers in Severe Liver Disease: Outcomes and Management. J Clin Transl Hepatol. 2019 Mar 28;7(1):32-39. doi: 10.14218/JCTH.2018.00059. Epub 2019 Mar 10.

    PubMed 30944817
  • Lashen SA, Shamseya MM, Shamseya AM, Hablass FH. Efficacy of Vonoprazan vs. Pantoprazole or Non-acid Suppression in Prevention of Post-variceal Ligation Ulcer Bleeding in Portal Hypertension: A Multi-arm Randomized Controlled Trial. J Clin Exp Hepatol. 2023 Nov-Dec;13(6):962-971. doi: 10.1016/j.jceh.2023.05.008. Epub 2023 May 19.

    PubMed 37975046
  • Oshima T, Miwa H. Potent Potassium-competitive Acid Blockers: A New Era for the Treatment of Acid-related Diseases. J Neurogastroenterol Motil. 2018 Jul 30;24(3):334-344. doi: 10.5056/jnm18029.

    PubMed 29739175
  • Lo EA, Wilby KJ, Ensom MH. Use of proton pump inhibitors in the management of gastroesophageal varices: a systematic review. Ann Pharmacother. 2015 Feb;49(2):207-19. doi: 10.1177/1060028014559244.

    PubMed 25583938
  • Garcia-Saenz-de-Sicilia M, Sanchez-Avila F, Chavez-Tapia NC, Lopez-Arce G, Garcia-Osogobio S, Ruiz-Cordero R, Tellez-Avila FI. PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis. World J Gastroenterol. 2010 Dec 14;16(46):5869-73. doi: 10.3748/wjg.v16.i46.5869.

    PubMed 21155009
  • Cho E, Jun CH, Cho SB, Park CH, Kim HS, Choi SK, Rew JS. Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies? Medicine (Baltimore). 2017 Jun;96(24):e7157. doi: 10.1097/MD.0000000000007157.

    PubMed 28614248
  • Hidaka H, Nakazawa T, Wang G, Kokubu S, Minamino T, Takada J, Tanaka Y, Okuwaki Y, Watanabe M, Tanabe S, Shibuya A, Koizumi W. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial. J Gastroenterol. 2012 Feb;47(2):118-26. doi: 10.1007/s00535-011-0472-0. Epub 2011 Sep 28.

    PubMed 21947706
  • Polski JM, Brunt EM, Saeed ZA. Chronology of histological changes after band ligation of esophageal varices in humans. Endoscopy. 2001 May;33(5):443-7. doi: 10.1055/s-2001-14259.

    PubMed 11396765
  • Lin L, Cui B, Deng Y, Jiang X, Liu W, Sun C. The Efficacy of Proton Pump Inhibitor in Cirrhotics with Variceal Bleeding: A Systemic Review and Meta-Analysis. Digestion. 2021;102(2):117-127. doi: 10.1159/000505059. Epub 2020 Feb 21.

    PubMed 32088712
  • Sinclair M, Vaughan R, Angus PW, Gow PJ, Parker F, Hey P, Efthymiou M. Risk factors for band-induced ulcer bleeding after prophylactic and therapeutic endoscopic variceal band ligation. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):928-32. doi: 10.1097/MEG.0000000000000387.

    PubMed 25951490
  • Petrasch F, Grothaus J, Mossner J, Schiefke I, Hoffmeister A. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis. BMC Gastroenterol. 2010 Jan 15;10:5. doi: 10.1186/1471-230X-10-5.

    PubMed 20074379
  • de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/j.jhep.2021.12.022. Epub 2021 Dec 30.

    PubMed 35120736

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Vonoprazan and Rabeprazol in people with Endoscopic Variceal Band Ligation, run by King George's Medical University at 1 site in India.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 27 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Dr Sumit Rungta, DM- Medical Gastroenterology (+919935537944, drsumitrungta79@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

To compare the maximum post-EVL esophageal ulcer diameter (mm) at 2 weeks (Day 14), measured on surveillance upper GI endoscopy, between the Vonoprazan and Rabeprazole groups. (time frame: Two weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07608536, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 May 2026.

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