TIPS proved more effective than glue injection in preventing rebleeding from gastric varices, with similar survival and frequency of complications.

s u m m a r yBackground: Upper gastrointestinal bleeding of all causes has a higher morbidity and mortality in older patients compared with younger patients. We retrospectively studied gastric variceal bleeding in older patients and compared the complications and outcomes of endoscopic variceal obliteration with younger patients. Methods: From August 2002 to August 2010, a total of 76 patients with gastric variceal bleeding who had received endoscopic variceal obliteration using Histoacryl as an adhesive agent by a single endoscopist were studied. Their chart records were obtained and reviewed with data collection. Patient demographics, laboratory parameters, etiology of liver cirrhosis, Child-Pugh classification, endoscopic findings, complications after endoscopic treatment, and mortality were gathered and analyzed. Results: A total of 26 (34.2%) of the 76 patients were older than 64 years. There were patients who were younger than 64 years who had more variceal bleeding as compared with the older patients. In older patient groups, women were more likely to have gastric variceal bleeding than their male counterparts. The most common type of gastric varices was gastroesophageal varices type 2 (GOV2). Significant difference existed in the etiology of cirrhosis between the two groups, with more hepatitis B and alcoholic hepatitis in the younger patients and more hepatitis C in the older patients. Significantly more Child-Pugh classification B and C cases were noticed in the younger patients. There were no significant differences of mortality and complications after treatment, including recurrent bleeding and sepsis, between the older and younger patients. Conclusion: There was no significant difference in outcomes after endoscopic treatment between the younger and the older patient groups. Endoscopic variceal obliteration using Histoacryl as an adhesive agent could be applied to treat older patients with gastric variceal bleeding just as it is for younger patients.