Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding

Rajoriya, Neil; Eh, Forrest; Gray, Joanna; Stuart, RC; Rc, Carter; Cj, McKay; Dr, Gaya; Morris, AJ; Stanley, Adrian J.

doi:10.1093/qjmed/hcq161

Cited by 38 publications

(28 citation statements)

References 36 publications

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“…However others have not confirmed this [17] . There may be a role for ultrasound mini-probes in the future to assess variceal obliteration, but at present this remains an investigative technique.…”

Section: Use Of Eusmentioning

confidence: 88%

“…Case reports of thromboembolic episodes to the pulmonary cerebral and coronary circulation after tissue adhesive injection have also been described [16] . A United Kingdom study achieved an immediate haemostasis rate of 100% with endoscopic histoacryl injection in gastric variceal bleeding [17] , and Al-Ali et al [18] reported a haemostasis rate of 95% in a Canadian population. Both studies reported no significant complications.…”

Section: Sclerotherapymentioning

confidence: 99%

“…Current evidence of the use of tissue adhesives for gastric variceal bleeding suggests haemostasis control in > 90%. Table 1 summarizes some of the larger and most recent studies using cyanoacrylate for the treatment of gastric varices [14,15,[17][18][19][20][21] . A randomized trial of cyanoacrylate injection vs TIPS for gastric variceal bleeding showed similar survival and complication rates in both groups, but TIPS was more effective in preventing rebleeding (11% vs 38%) [22] .…”

Section: Sclerotherapymentioning

confidence: 99%

“…Ramesh and colleagues also studied bovine thrombin in the management of bleeding gastric varices [27] . Cheng et al [19] Case series 613 (30 mo) 23% 95% 8% 5% "major" Kang et al [15] Retrospective 127 (18 mo) 38% 98% 23% 3 % "major" Seewaldet al [20] Retrospective 131 (26 mo) 63% 100% 7% 0% Paik et al [14] Retrospective 121 (12 mo) 26% 91% 13% (at 4 wk) 2% (major complications) Kind et al [21] Case series 174 (36 mo) 100% 97% 13% "late rebleeding" 8% Ali-Al et al [18] Retrospective 37 (14 mo) 86% 95% 28% 0 % "major" Rajoriyaet al [17] Retrospective 31 (35 mo) Not recorded 100% 16% 0 % "major" 6% "minor"…”

Section: Sclerotherapymentioning

confidence: 99%

“…The United Kingdom study reporting long-term results of endoscopic histoacryl injection in gastric variceal bleeding reported a rebleeding rate of 16%. The mean overall follow-up was 35 mo [17] . The Canadian study, with a median follow-up period of 14 mo, reported a late rebleeding rate of 28% [18] .…”

Section: Endoscopic Therapiesmentioning

confidence: 99%

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Update on gastric varices

Triantafyllou

Stanley

2014

WJGE

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Although less common than oesophageal variceal haemorrhage, gastric variceal bleeding remains a serious complication of portal hypertension, with a high associated mortality. In this review we provide an update on the aetiology, classification and management of gastric varices, including acute bleeding, prevention of rebleeding and primary prophylaxis. We describe the optimum management strategies for gastric varices including drug, endoscopic and radiological therapies, focusing on recent published evidence. Key words: Varices; Gastric; Portal hypertension; Tissue glue; Transjugular intrahepatic portosystemic shunt Core tip: Endoscopic injection of cyanoacrylate is currently the optimum, evidenced based approach to control active bleeding from gastric varices, apart from bleeding from gastro-oesophageal varice (GOV)-1 which can be treated with variceal band ligation. Transjugular intrahepatic portosystemic shunt (or balloon-occluded retrograde transvenous obliteration in experienced units) can be effective for ongoing bleeding. Cyanoacrylate or transjugular intrahepatic portosystemic shunt can pre-

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Section: Use Of Eusmentioning

confidence: 88%

Section: Sclerotherapymentioning

confidence: 99%

Section: Sclerotherapymentioning

confidence: 99%

Section: Sclerotherapymentioning

confidence: 99%

Section: Endoscopic Therapiesmentioning

confidence: 99%

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Update on gastric varices

Triantafyllou

Stanley

2014

WJGE

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Management Options for Gastric Variceal Hemorrhage

et al. 2019

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irrhosis is a serious complication of liver disease and is commonly caused by viral hepatitis and alcohol consumption. 1,2 Cirrhosis causes abnormal cellular alterations, which increase vascular resistance through the liver. Cirrhosis also comes with cellular damage, tissue fibrosis, liver hardening, nodule formation, and sinusoidal remodeling. Damage to the hepatocytes also results in a disruption of the normal equilibrium between vasodilators and vasoconstrictors and increases total blood flow into the portal system. Endogenous vasodilators such as nitric oxide increase the amount of blood flowing into the portal system by inducing splanchnic arteriolar vasodilation. Following the Ohm law, an increase in vascular resistance along with an increase in portal inflow results in an increase in portal pressure. Subsequently, cirrhosis results in clinical manifestations of portal hypertension.Owing to the variability in severity and progression, cirrhosis is commonly classified into 2 stages: compensated and decompensated. Decompensated cirrhosis is more severe and results in major complications such as ascites, jaundice, encephalopathy and variceal hemorrhage. 1,2 Thus, it is imperative to monitor the progression of compensated cirrhosis and pay close attention to predictive markers of worsening portal hypertension, such as the hepatic venous pressure gradient (HVPG). An HVPG of 10 mm Hg or more is highly

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