Bucrylate Treatment of Bleeding Gastric Varices: 12 Years' Experience

Kind, R.; Guglielmi, Alfredo; Rodella, Luca; Lombardo, Francesca; Catalano, F. A.; Ruzzenente, Andrea; Borzellino, Giuseppe; Girlanda, R.; Leopardi, F; Pratticò, Francesco; Cordiano, Claudio

doi:10.1055/s-2000-3817

Cited by 102 publications

(62 citation statements)

References 14 publications

(29 reference statements)

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“…Furthermore, we found that the incidence of bleeding from gastric varices in our patients is 22.7%, which is also similar to other reports [5] . In this study, the rate for primary hemostasis with NBC injection is consistent with the reported rate of 90% to 97% in other studies [8,14,16,[21][22][23] . In our study, sclerotherapy with 2 mL NBC diluted in 1 mL lipoidal was effective in control of bleeding in all our patients during the first 48 h.…”

Section: Discussionsupporting

confidence: 92%

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Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

Mumtaz

Majid²,

Shah³

et al. 2007

WJG

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AIM:To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV). METHODS:We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed. RESULTS:The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV-Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P < 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50). CONCLUSION:GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding. In hospital mortality of patients with bleeding GV is 6%.

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Section: Discussionsupporting

confidence: 92%

“…Most reports on endoscopic treatment of bleeding gastric varices are small series, case reports, or retrospective reviews [14,15] . Not more than 1000 patients with bleeding GV have been treated with different sclerosing and coagulating agents.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

Mumtaz

Majid²,

Shah³

et al. 2007

WJG

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“…Fundal varices, like GOV2 and IGV1 of Sarin classification, are known to be associated with a high-flow vessel originating in gastro-renal, gastrophrenic or cardiophrenic shunts, and this distinctive anatomy and physiology contributes to a more aggressive bleeding potential [17]. Kind et al reported similar rebleeding rates among GOV1 (19.6 %) and GOV2 (18.9 %) varices but higher rebleeding rate in IGV1 (66.5 %) [18]. However, in our series, that was not verified.…”

Section: Discussionmentioning

confidence: 99%

“…Kind et al reported that hospital mortality rate was 19.5 %, and it was associated to liver failure (76 % of cases) and hemorrhagic shock (8.8 %) [18]. In our study, factors that were associated with in-hospital mortality, were: poor hepatic function (Child-Pugh C), no immediate hemostasis with cyanoacrylate, need for Sengstaken-Blakemore tube after cyanoacrylate, presence of complications, very early rebleeding and prothrombin rate <42 %.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

Monsanto

Almeida

Rosa

et al. 2012

Indian J Gastroenterol

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Background Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding. Patients and Methods Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic treatment with a mixture of N-butyl-2-cyanoacrylate and Lipiodol TM . Ninety-one patients had cirrhosis and 6 had non-cirrhotic portal hypertension. Child-Pugh score at presentation for cirrhotic patients was A-12.1 %; B-53.8 %; C-34.1 % and median MELD score at admission was 13 (3-26). Successful hemostasis, rebleeding rate and complications were reviewed. Median time of follow up was 19 months (0.5-126). Results A median mixture volume of 1.5 mL (0.6 to 5 mL), in 1 to 8 injections, was used, with immediate hemostasis rate of 95.9 % and early rebleeding rate of 14.4 %. One or more complications occurred in 17.5 % and were associated with the use of Sengstaken-Blakemore tube before cyanoacrylate and very early rebleeding (p<0.05). Hospital mortality rate during initial bleeding episode was 9.3 %. Very early rebleeding was a strong and independent predictor for in-hospital mortality (p<0.001). Long-term mortality rate was 58.8 %, in most of the cases secondary to hepatic failure. Conclusion N-butyl-2-cyanoacrylate is a rapid, easy and highly effective modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Patients with very early rebleeding are at higher risk of death.

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“…Cyanoacrylate has been used widely in the management of bleeding gastric varices empirically and achieved a rather satisfactory hemostatic rate. 4 The rationale of using cyanoacrylates is to occlude large varices and eradicate varices rapidly. 5 Our results showed the superiority of cyanoacrylate injection over band ligation.…”

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2002

Hepatology

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Bucrylate Treatment of Bleeding Gastric Varices: 12 Years' Experience

Cited by 102 publications

References 14 publications

Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

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