Cyanoacrylate Injection Compared with Band Ligation for Acute Gastric Variceal Hemorrhage: A Meta-Analysis of Randomized Controlled Trials and Observational Studies

Ye, Xiaohua; Huai, Jiaping; Chen, Yanping

doi:10.1155/2014/806586

Cited by 5 publications

(6 citation statements)

References 37 publications

(134 reference statements)

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“…42-44 In a recent meta-analysis involving 648 patients with bleeding gastric varices (all types), pooled analysis suggested better efficacy of EVO in achieving primary hemostasis, and lower rebleeding rates (OR 2.32; 95% CI 1.19-4.51). 45 There was no difference between EVO and EVBL in terms of mortality, complications and number of treatment sessions required for complete variceal eradication. There were significant heterogeneity among the studies in terms of techniques used, type and dose of cyanoacrylate, number of injections, however.…”

Section: Endoscopic Management Of Gastric Variceal Hemorrhagementioning

confidence: 83%

Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding

Kapoor

Dharel

Sanyal

2015

Gastrointestinal Endoscopy Clinics of North America

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Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding and second line definitive therapies introduced quickly if endoscopic and pharmacologic treatment fails.

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Section: Endoscopic Management Of Gastric Variceal Hemorrhagementioning

confidence: 83%

Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding

Kapoor

Dharel

Sanyal

2015

Gastrointestinal Endoscopy Clinics of North America

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“…Several systematic reviews/meta-analyses have evaluated the efficacy of cyanoacrylate injection for the treatment of GVH [105][106][107][108][109] also significantly better in preventing the recurrence of gastric varices (36.0 % vs. 66.0 %; P = 0.002). There was no difference in AEs or mortality between the two groups.…”

Section: Initial Managementmentioning

confidence: 99%

“…Several systematic reviews/meta-analyses have evaluated the efficacy of cyanoacrylate injection for the treatment of GVH 105 106 107 108 109 . Qiao et al reported on three RCTs, which included 194 patients with active gastric variceal bleeding, comparing endoscopic cyanoacrylate injection versus EBL 106 .…”

Section: Endoscopic Managementmentioning

confidence: 99%

Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2022

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Main Recommendations 1 ESGE recommends that patients with compensated advanced chronic liver disease (ACLD; due to viruses, alcohol, and/or nonobese [BMI < 30 kg/m2] nonalcoholic steatohepatitis) and clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] > 10 mmHg and/or liver stiffness by transient elastography > 25 kPa) should receive, if no contraindications, nonselective beta blocker (NSBB) therapy (preferably carvedilol) to prevent the development of variceal bleeding.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in those patients unable to receive NSBB therapy with a screening upper gastrointestinal (GI) endoscopy that demonstrates high risk esophageal varices, endoscopic band ligation (EBL) is the endoscopic prophylactic treatment of choice. EBL should be repeated every 2–4 weeks until variceal eradication is achieved. Thereafter, surveillance EGD should be performed every 3–6 months in the first year following eradication.Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute upper GI hemorrhage (UGIH) and no history of cardiovascular disease, a restrictive red blood cell (RBC) transfusion strategy, with a hemoglobin threshold of ≤ 70 g/L prompting RBC transfusion. A post-transfusion target hemoglobin of 70–90 g/L is desired.Strong recommendation, moderate quality evidence. 4 ESGE recommends that patients with ACLD presenting with suspected acute variceal bleeding be risk stratified according to the Child–Pugh score and MELD score, and by documentation of active/inactive bleeding at the time of upper GI endoscopy.Strong recommendation, high quality of evidence. 5 ESGE recommends the vasoactive agents terlipressin, octreotide, or somatostatin be initiated at the time of presentation in patients with suspected acute variceal bleeding and be continued for a duration of up to 5 days.Strong recommendation, high quality evidence. 6 ESGE recommends antibiotic prophylaxis using ceftriaxone 1 g/day for up to 7 days for all patients with ACLD presenting with acute variceal hemorrhage, or in accordance with local antibiotic resistance and patient allergies.Strong recommendation, high quality evidence. 7 ESGE recommends, in the absence of contraindications, intravenous erythromycin 250 mg be given 30–120 minutes prior to upper GI endoscopy in patients with suspected acute variceal hemorrhage.Strong recommendation, high quality evidence. 8 ESGE recommends that, in patients with suspected variceal hemorrhage, endoscopic evaluation should take place within 12 hours from the time of patient presentation provided the patient has been hemodynamically resuscitated.Strong recommendation, moderate quality evidence. 9 ESGE recommends EBL for the treatment of acute esophageal variceal hemorrhage (EVH).Strong recommendation, high quality evidence. 10 ESGE recommends that, in patients at high risk for recurrent esophageal variceal bleeding following successful endoscopic hemostasis (Child–Pugh C ≤ 13 or Child–Pugh B > 7 with active EVH at the time of endoscopy despite vasoactive agents, or HVPG > 20 mmHg), pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) within 72 hours (preferably within 24 hours) must be considered.Strong recommendation, high quality evidence. 11 ESGE recommends that, for persistent esophageal variceal bleeding despite vasoactive pharmacological and endoscopic hemostasis therapy, urgent rescue TIPS should be considered (where available).Strong recommendation, moderate quality evidence. 12 ESGE recommends endoscopic cyanoacrylate injection for acute gastric (cardiofundal) variceal (GOV2, IGV1) hemorrhage.Strong recommendation, high quality evidence. 13 ESGE recommends endoscopic cyanoacrylate injection or EBL in patients with GOV1-specific bleeding.Strong recommendations, moderate quality evidence. 14 ESGE suggests urgent rescue TIPS or balloon-occluded retrograde transvenous obliteration (BRTO) for gastric variceal bleeding when there is a failure of endoscopic hemostasis or early recurrent bleeding.Weak recommendation, low quality evidence. 15 ESGE recommends that patients who have undergone EBL for acute EVH should be scheduled for follow-up EBLs at 1- to 4-weekly intervals to eradicate esophageal varices (secondary prophylaxis).Strong recommendation, moderate quality evidence. 16 ESGE recommends the use of NSBBs (propranolol or carvedilol) in combination with endoscopic therapy for secondary prophylaxis in EVH in patients with ACLD.Strong recommendation, high quality evidence.

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“…29 It has proven to be more effective and safer than band ligation and sclerotherapy in this subset of patients and has been considered as standard therapy in Europe, the Middle East, and Asia for more than 25 years. 30 In our daily practice, we use always a mixture of N-butyl-2-cyanoacrylate and lipiodol for bleeding gastric varices using a dedicated 21-gauge needle with the purpose of obliterating the bleeding gastric varices and those at risk to bleed (Supplementary Video 2). 31 Novel Endoscopic Modalities for Variceal Bleeding…”

Section: Management Of the Acute Variceal Bleeding Episodementioning

confidence: 99%