We extend our congratulations to Tevethia et al for their recently published ‘CAVARLY trial’, which suggests the combination of variceal band ligation (VBL) and carvedilol is superior to VBL or carvedilol alone in the reduction of the first episode of oesophageal variceal bleeding (OVB) in patients with high-risk varices.1 This is the first primary prophylaxis randomised control trial to examine combination therapy and provides some interesting results which require further thought.

Despite significantly lower rates of OVB and mortality in the combination therapy group, other indicators of disease severity such as; progression of ascites, …