Non-selective Beta-blocker in Compensated Advanced Chronic Liver Disease

Exclusion Criteria

• •Presence of high-risk varices (HRV) (i.e. moderate to large oesophageal varices \[OV\] or OV with red wale sign) found in OGD
• •Current use of non-selective beta-blocker (NSBB) or any use of NSBB within 6 months before
• •* Use of selective beta blocker, such as atenolol or metoprolol, is not excluded
• •* Selective beta-blocker will be switched to carvedilol in NSBB arm, and will be kept unchanged in conventional arm if there is clinical need for the selective beta-blocker
• •Contraindication to NSBB (e.g. Type II/III heart block or baseline bradycardia \<60/minute, hypotension with systolic blood pressure (SBP) \<100 mmHg, asthma, poorly controlled chronic obstructive pulmonary disease, and peripheral vascular disease)
• •Current use of nitrated drugs or any use of nitrated drugs within 6 months before
• •o Use of sublingual nitrate, such as glyceryl trinitrate, is not excluded
• •Contraindication to OGD (e.g. Intestinal perforation or obstruction)
• •Current or history of decompensated liver cirrhosis (i.e. Child's C cirrhosis, prior decompensating events such as ascites, variceal bleeding, hepatic encephalopathy and hepatorenal syndrome)
• •o Child's B cirrhosis without decompensating events is not excluded
• •Current or history of hepatocellular carcinoma (HCC)
• •Current or history of portal vein thrombosis
• •Transjugular intrahepatic portosystemic shunt (TIPS)
• •Liver transplantation
• •Serious medical illness with limited life expectancy of less than 6 months
• •Pregnancy
• •Unable to obtain or refusal of informed consent from patient