medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2014, Number 1

<< Back Next >>

Ann Hepatol 2014; 13 (1)

Band ligation vs. N-Butyl-2-cyanoacrylate injection in acute gastric variceal bleeding: a prospective follow-up study

Tantau M, Crisan D, Popa D, Vesa S, Tantau A

Language: English
References: 34
Page: 75-83
PDF size: 107.78 Kb.


ABSTRACT

Background. Treatment of gastric varices (GV) implies a number of several difficulties and sometimes entails complications. The best endoscopic success rate was attributed until now to the use of tissue adhesives(N-Butyl-2-Cyanoacrylate) and band ligation. Aim. To assess the therapeutic efficacy and safety of cyanoacrylate injection compared to band ligation in patients with acute GV hemorrhage. Material and methods. Thirty-seven patients with upper gastrointestinal bleeding from GV were included in the study, treated with cyanoacrylate injection (GVO)-19 patients or band ligations (GVL)-18 patients. They were followed up for overall results, complications and survival rate. Results. The mean age of the study group was 60.22 ± 9.34 years, with a male/female ratio of 21:16. The mean follow-up period was 427.26 ± 214.16 days in the GVO group and 406.21 ± 213.23 days in the GVL group (p = 0.76). Initial hemostasis was achieved in all patients treated with cyanoacrylate and in 88.88% from the GVL group (p = 0.43). Rebleeding occurred in 72.22% of the GVL group and in 31.57% of the GVO patients (p = 0.03). Patients in the GVO group had a significantly larger rebleeding-free period(p = 0.006). No difference was found in survival rates(p = 0.75). The Child Class (p = 0.003 for Class C) and treatment method (p = 0.01) were independently associated with the rate of rebleeding. No differences were found regarding the rate of complications. Conclusion. The use of cyanoacrylate in acute GV bleeding had better results when compared with band ligation in terms of controlling the hemorrhage and recurrence of bleeding. The overall survival rate was not influenced by the method used for the treatment of complicated GV.


REFERENCES

  1. Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J. The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data. Gastrointest Endosc 1981; 27: 73-9.

  2. Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, Pandya P, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 2003; 98(3): 653-9.

  3. Sharma P, Sarin SK. Improved survival with the patients with variceal bleed. Int J Hepatol 2011; 356919. doi: 10.4061/2011/356919. Epub 2011 Jul 7.

  4. Helmy A, Hayes PC. Review article: current endoscopic therapeutic options in the management of variceal bleeding. Aliment Pharmacol Ther 2001; 15: 575-94.

  5. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16: 1343-9.

  6. Northup PG, Caldwell SH. Treatment of bleeding gastric varices. J Gastroenterol Hepatol 2005; 20: 1631-3.

  7. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986; 32: 264-8.

  8. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection vs. band ligation in the management of bleeding gastric varices. Hepatology 2001; 33: 1060-4.

  9. Tan PC, Hou MC, Lin HC, Liu TT, Lee FY, Chang FY, Lee SD. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-Butyl-2-Cyanoacrylate injection vs. band ligation. Hepatology 2006; 43: 690-7.

  10. Pugh RNN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of esophagus for bleeding esophageal varices. Br J Surg 1973; 60: 646-9.

  11. de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53: 762-8.

  12. Ramond MJ, Valla D, Mosnier JF, Degott C, Bernuau J, Rueff B, Benhamou JP. Successful endoscopic obturation of gastric varices with butyl cyanoacrylate. Hepatology 1989; 10: 488-93.

  13. Hou MC, Lin HC, Kuo BI, Lee FY, Schmidt CM, Lee SD. Clinical implications of the white nipple sign and its role in the diagnosis of esophageal variceal hemorrhage. Am J Gastroenterol 1996; 91: 2103-9.

  14. Yoshida T, Harada T, Shigemitsu T, Takeo Y, Miyazaki S, Okita K. Endoscopic management of gastric varices using a detachable snare and simultaneous endoscopic sclerotherapy and O-ring ligation. J Gastroenterol Hepatol 1999; 14: 730-5.

  15. Arakaki Y, Murakami K, Takahashi K, Sato R, Okimoto T, Ishitobi H, Nasu M, et al. Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis. Endoscopy 2003; 35: 940-5.

  16. Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial ofcyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol 2002; 97: 1010-5.

  17. Hou MC, Lin HC, Lee HS, Liao WC, Lee FY, Lee SD. A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL. Gastrointest Endosc 2009; 70: 668-75.

  18. Kind R, Guglielmi A, Rodella L, Lombardo F, Catalano F, Ruzzenente A, Borzellino G, et al. Bucrylate treatment of bleeding gastric varices: 12 years’ experience. Endoscopy 2000; 32: 512-9.

  19. Akahoshi T, Hashizume M, Shimabukuro R, Tanoue K, Tomikawa M, Okita K, Gotoh N, et al. Long-term results of endoscopic histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery 2002; 131: S176-81.

  20. Oho K, Iwao T, Sumino M, Toyonaga A, Tanikawa K. Ethanolamine oleate vs. butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy 1995; 27: 349-54.

  21. Cipolletta L, Bianco MA, Rotondano G, Piscopo R, Prisco A, Garofano ML. Emergency endoscopic ligation of actively bleeding gastric varices with a detachable snare. Gastrointest Endosc 1998; 47: 400-3.

  22. Shiha G, El-Sayed SS. Gastric variceal ligation: a new technique. Gastrointest Endosc 1999; 49: 437-41.

  23. Harada T, Yoshida T, Shigemitsu T, Takeo Y, Tada M, Okita K. Therapeutic results of endoscopic variceal ligation for acute bleeding of oesophageal and gastric varices. J Gastroenterol Hepatol 1997; 12: 331-5.

  24. Feretis C, Tabakopoulos D, Benakis P, Xenofontos M, Golematis B. Endoscopic hemostasis of esophageal and gastric variceal bleeding with histoacryl. Endoscopy 1990; 22: 282-4.

  25. Iwase H, Maeda O, Shimada M, Tsuzuki T, Peek RM Jr, Nishio Y, Ando T, et al. Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding. Gastrointest Endosc 2001; 53: 585-92.

  26. Dhiman RK, Chawla Y, Taneja S, Biswas R, Sharma TR, Dilawari JB. Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate. J Clin Gastroenterol 2002; 35: 222-7.

  27. Greenwald BD, Caldwell SH, Hespenheide EE, Patrie JT, Williams J, Binmoeller KF, Woodall L, et al. N-2-butyl-cyanoacrylate for bleeding gastric varices: a United States pilot study and cost analysis. Am J Gastroenterol 2003; 98: 1982-8.

  28. Sheikh RA, Trudeau WL. Clinical evaluation of endoscopic injection sclerotherapy using N-butyl-2-cyanoacrylate for gastric variceal bleeding. Gastrointest Endosc 2000; 52: 142-4.

  29. Ogawa K, Ishikawa S, Naritaka Y, Shimakawa T, Wagatsuma Y, Katsube A, Kajiwara T. Clinical evaluation of endoscopic injection sclerotherapy using n-butyl-2-cyanoacrylate for gastric variceal bleeding. J Gastroenterol Hepatol 1999; 14: 245-50.

  30. Roesch W, Rexroth G. Pulmonary, cerebral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy 1998; 30: S89-9.

  31. Hwang SS, Kim HH, Park SH, Kim SE, Jung JI, Ahn BY, Kim SH, et al. N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding. J Comput Assist Tomogr 2001; 25: 16-22.

  32. Palejwala AA, Smart HL, Hughes M. Multiple pulmonary glue emboli following gastric variceal obliteration. Endoscopy 2000; 32: S1-2.

  33. Yu LK, Hsu CW, Tseng JH, Liu NJ, Sheen IS. Splenic infarction complicated by splenic artery occlusion after N-butyl- 2-cyanoacrylate injection for gastric varices: case report. Gastrointest Endosc 2005; 61: 343-5.

  34. Bernard B, Grangé JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999; 29: 1655-61.




2020     |     www.medigraphic.com