Endoscopic injection sclerotherapy versus conservative treatment for patients with unresectable hepatocellular carcinoma and bleeding esophageal varices

Lo, Gin‐Ho; Lin, Ching‐Yih; Lai, Kwok‐Hung; Malik, Uzair; Ng, Wai-Wah; Lee, Fa-Yauh; Lee, Shou‐Dong; Tsai, Yang‐Te; Lo, Kwang‐Juei

doi:10.1016/s0016-5107(91)70677-9

Cited by 30 publications

(15 citation statements)

References 24 publications

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“…A previous study indicated that N-butyl-2-cyanoacrylate injection had little infl uence on the survival of patients with advanced liver failure. [38][39][40] In this study, fi ve patients died from liver failure during the 5-year followup period, but EIS with cyanoacrylate had no direct infl uence on liver function. The results of the combination therapy used in this study raise the question as whether it should be applied for initial treatment of all patients presenting with acute gastric variceal bleeding.…”

Section: Discussionmentioning

confidence: 62%

Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate

Sugimoto

Watanabe

et al. 2007

J Gastroenterol

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Section: Discussionmentioning

confidence: 62%

Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate

Sugimoto

Watanabe

et al. 2007

J Gastroenterol

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“…Actually, other than the treatment method, HCC was the only independent factor influencing GV rebleeding with a hazard ratio of approximately 2.5, which is consistent with previous reports that have shown that the presence of HCC is an extremely good predictor of rebleeding in patients with EVH. [26][27][28] Except for infections, complications were unusual in patients who underwent GVL or GVO. Actually, bacterial infection often coexists with acute variceal hemorrhage and has been documented in 35% to 60% of patients with cirrhosis who have variceal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…The rebleeding rate of GV was 0% to 18.5% for GVL and 10% to 42% for GVO. 12 Because of highly prevalent HCC in this area, [21][22][23][24][25] a larger number of patients with HCC, a risk factor for variceal rebleeding, [26][27][28][29] were included in this study. Therefore, estimates of sample size were based on a rebleeding rate assumed to be 15% for the GVL group and 40% for the GVO group.…”

Section: Methodsmentioning

confidence: 99%

A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-Butyl-2-Cyanoacrylate injection versus band ligation

et al. 2006

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Progression of gastric variceal hemorrhage (GVH) is poorer than esophageal variceal bleeding. However, data on its optimal treatment are limited. We designed a prospective study to compare the efficacy of endoscopic band ligation (GVL) and endoscopic N-butyl-2-cyanoacrylate injection (GVO). Liver patients with cirrhosis with or without concomitant hepatocellular carcinoma (HCC) and patients presenting with acute GVH were randomized into two treatment groups. Forty-eight patients received GVL, and another 49 patients received GVO. Both treatments were equally successful in controlling active bleeding (14/15 vs. 14/15, P ‫؍‬ 1.000). More of the patients who underwent GVL had GV rebleeding (GVL vs. GVO, 21/48 vs. 11/49; P ‫؍‬ .044). The 2-year and 3-year cumulative rate of GV rebleeding were 63.1% and 72.3% for GVL, and 26.8% for both periods with GVO; P ‫؍‬ .0143, log-rank test. The rebleeding risk of GVL was sustained throughout the entire follow-up period. Multivariate Cox regression indicated that concomitance with HCC (relative hazard: 2.453, 95% CI: 1.036-5.806, P ‫؍‬ .041) and the treatment method (GVL vs. GVO, relative hazard: 2.660, 95% CI: 1.167-6.061, P ‫؍‬ .020) were independent factors predictive of GV rebleeding. There was no difference in survival between the two groups. Severe complications attributable to these two treatments were rare. In conclusion, the efficacy of GVL to control active GVH appears not different to GVO, but GVO is associated with a lower GV rebleeding rate. (HEPATOLOGY 2006;43:690-697.) A lthough the outcome of variceal hemorrhage has improved over the past two decades, variceal hemorrhage is still the most serious complication of portal hypertension and chronic liver disease. 1 Although bleeding occurs less often from gastric varices (GV) than from esophageal varices (EV) (esophageal variceal hemorrhage [EVH] accounts for 70% to 80% of variceal hemorrhage), it has a poorer prognosis and is associated with more severe blood loss, a higher rebleeding rate, and a higher mortality rate. 1-3 However, limited data exist on the best treatment for GV hemorrhage (GVH). Endoscopic treatment is an alternative in the management of GVH and includes endoscopic injection of sclerosants or thrombin, 4,5 endoscopic band ligation, 6,7 and others. The success rate in controlling GVH by endoscopic injection of N-butyl-2-cyanoacrylate (GVO) appears higher than for other sclerosants according to previous non-randomized trials. 8,9 Though endoscopic variceal ligation is regarded as the optimal endoscopic treatment for EVH, 10 its safety and efficacy for the treatment of GVH is uncertain. 7,11 The rebleeding rate of GVO is variable and ranges from 10% to 42%. 12 At the time we started this trial, there were no randomized control trials, and even now, there is only one relatively small randomized clinical trial, 13 which was conducted to compare these two potential treatment modalities (endoscopic band ligation [GVL] vs. GVO) on the GVH; it showed results in favor of GVO for the treatment of GVH. We...

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“…However, most of those trials were done in patients who had relatively good liver function. Patients with poor liver function require prophylactic therapy because the risk of bleeding from varices is considered high in patients with severe liver disease . Variceal bleeding can occur at any time in the remainder of these patients' lives and is usually a terminal event .…”

Section: Discussionmentioning

confidence: 99%

Merits of prophylactic sclerotherapy for esophageal varices concomitant unresectable hepatocellular carcinoma: Prospective randomized study

Akahoshi

Tomikawa

Tsutsumi

et al. 2013

Digestive Endoscopy

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Endoscopic injection sclerotherapy versus conservative treatment for patients with unresectable hepatocellular carcinoma and bleeding esophageal varices

Cited by 30 publications

References 24 publications

Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate

Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate

A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-Butyl-2-Cyanoacrylate injection versus band ligation

Merits of prophylactic sclerotherapy for esophageal varices concomitant unresectable hepatocellular carcinoma: Prospective randomized study

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