Clinical outcomes of gastric variceal obliteration using<i>N</i>-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

Jun, Chung Hwan; Kim, Ka Rham; Yoon, Jeong Seon; Koh, Han Ra; Choi, Won Suk; Cho, Kyu Man; Lim, Sung Uk; Park, Chang Hwan; Joο, Young Eun; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun

doi:10.3904/kjim.2014.29.4.437

Cited by 32 publications

(28 citation statements)

References 23 publications

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“…[5,6] Most of the available information about upper gastrointestinal ectopic variceal bleeding control is acquired from case reports or small case series. Randomized controlled trials have also not been reported.…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Park

Cho²,

Jun³

et al. 2017

Medicine

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Rationale:Ectopic variceal bleeding is a rare (2–5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results.Patient concerns:We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years.Diagnoses:All patients were diagnosed with liver cirrhosis presenting melena or hematemesis.Interventions:All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case).Outcomes:Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case.Lessons:EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

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Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Park

Cho²,

Jun³

et al. 2017

Medicine

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“…Similarly, some studies have demonstrated close association between Child-Pugh scores and recurrent bleeding risk of variceal bleeds that ceased spontaneously or as a result of treatment [22, 23]. Distribution of patients according to groups based on Child-Pugh stages revealed that cirrhotic patients in Child A stage were more numerous in all groups with gastric varices.…”

Section: Discussionmentioning

confidence: 90%

The relationship between the size of varices and platelet count/spleen size ratio in cirrhotic patients

Öztürk¹

2016

North Clin Istanbul

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OBJECTIVE:This study investigated the relationship between size of gastroesophageal varices and platelet count/spleen diameter ratio in cirrhotic patients.METHODS:The present study included 186 cirrhotic patients in whom gastroesophageal varices were seen during upper gastrointestinal system endoscopy. Clinical features, laboratory parameters, upper gastrointestinal system endoscopy, and abdominal ultrasonographic findings of patients were evaluated retrospectively. Platelet count/spleen diameter ratio (P/S) was calculated by dividing number of platelets in complete blood count (CBC) to largest diameter of spleen. Varices were classified as small, medium, or large, and patients were separated into two groups for comparison: those with small varices and those with medium or large varices. Of the total, 66.7 % of the patients were men (n=124) and 33.3% were women (n=62). Esophageal varices were found in 82.7% and gastric varices were found in 17.3%.RESULTS:Patients with large esophageal varices were found to have significantly lower P/S compared to patients with small esophageal varices (p=0.04). In receiver operating characteristic (ROC) curve analysis, P/S and large varices correlated with 82% sensitivity and 79% positive predictive value. However, no statistically significant correlation between size of varices and P/S was found in patients with gastric varices (p=0.78).CONCLUSION:In patients with esophageal varices, P/S was found to be correlated with large varices with 82% sensitivity. However, this ratio did not predict large varices in patients with gastric varices. Prospective and randomized clinical researches are needed to clarify our findings.

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“…Our study found that patients with EVs+ GOV2 with GOV1 had an increased risk of rebleeding at 1 year, and EVs+ GOV2 with GOV1 was identi ed as an independent risk factor (OR=31.063, 95% CI: 1.560-618.4).Kang EJ et al reported the incidence of rebleeding incident of in patients with liver cancer (P<0.001) and GOV2 (P=0.009) was signi cantly increased at 1-year when comparing the prognosis of 127 GV patients (GOV1:GOV2: IGV=56:61:10) who had been treated with tissue glue for preventing rebleeding (23). Jun CH et al retrospectively analyzed reported 455 GVs patients after endoscopic treatment showed that no different in rebleeding for 1-year between the GOV1 and GOV2 (24), however, the comparing between EV+GOV2 without GOV1 group and EV+GOV2 with GOV1 group was not complete. We found a signi cant difference in the incidence of rebleeding at 1-year between EV+GOV2 without GOV1 group and EV+GOV2 with GOV1 group.…”

Section: Discussionmentioning

confidence: 99%

Predictors of endoscopic prophylaxis for rebleeding in esophageal varices combined type 2 gastroesophageal varices

Jiang

Nie

Zhang

et al. 2020

Preprint

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Background: Patients with decompensated cirrhosis and esophageal varices (EVs) combined with type 2 gastroesophageal varices (GOV2) are at risk of rebleeding after endoscopic prophylaxis. This study was performed to evaluate the preventive efficacy of endoscopic treatment in patients with EVs combined with GOV2, and to identify the risk factor of rebleeding. Methods: We performed a single-center, observational, retrospective study of hospitalized patients with EVs combined with GOV2. The biochemical examination results, demographics, endoscopic performance measures and treatment methods of patients undergoing endoscopic treatment were collected. All patients were observed for 1-year, or were loss to follow-up. The predictors of rebleeding were analyzed by logistic regression analysis.Results: A total of 124 patients underwent endoscopic treatment, including 2 (1.6%) patients in whom bleeding failed to cease and 19 (15.3%) patients who were lost to follow-up. A total of 103 patients were observed until 1 year, including 11 (10.7%) patients who experienced rebleeding. The results indicated that EVs+GOV2 with GOV1, age, prothrombin time (PT), bilirubin level, platelet count, Child-Pugh grade, and model for end-stage liver disease (MELD) score were associated with rebleeding at 1 year in patients with EVs combined with GOV2. Multivariate logistic analysis revealed that age, EVs+GOV2 with GOV1, bilirubin level, and PT were independent risk factors for rebleeding.Conclusion: Endoscopic treatment is effective as a preventive treatment in patients with EVs combined with GOV2. EVs combined with GOV1, older age, coagulation failure, and increased bilirubin levels should be given close attention due to their associations with rebleeding after endoscopic prophylaxis. GOV1 may have a negative effect in patients with EVs +GOV2.

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Clinical outcomes of gastric variceal obliteration usingN-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

Cited by 32 publications

References 23 publications

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities

The relationship between the size of varices and platelet count/spleen size ratio in cirrhotic patients

Predictors of endoscopic prophylaxis for rebleeding in esophageal varices combined type 2 gastroesophageal varices

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