Management of bleeding gastric varices

Khawaja, Ali; Sonawalla, Ambreen; Somani, Sana; Abid, Shahab

doi:10.1097/meg.0000000000000080

Cited by 15 publications

(7 citation statements)

References 32 publications

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“…A single session of GV sclerotherapy (GVS) seems to be effective for the majority of patients with active GV bleeding. [ 17 ] One interesting finding of our study was the high frequency of second-look endoscopy. Although the hemostasis control rate was high (262/311, 84.2%), and only a few patients required a second procedure (12/311, 7%), one-fourth of patients had to undergo second-look endoscopy.…”

Section: Discussionmentioning

confidence: 83%

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No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage

Hung

Tsai

TsenK

et al. 2016

Saudi J Gastroenterol

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Background/Aims:The aim of this study was to compare the efficacy of terlipressin versus somatostatin as adjuvants to endoscopic treatment in cirrhotic patients with gastric variceal bleeding.Patients and Methods:The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to enroll patients who were discharged with International Classification of Diseases, 9th Revision, Clinical Modification diagnoses of cirrhosis and who underwent gastric variceal sclerotherapy for gastric variceal bleeding between January 1, 2007, and December 31, 2007. We observed treatment outcomes and identified clinical factors associated with mortality.Results:In total, we enrolled 311 cirrhosis patients who underwent sclerotherapy for active gastric variceal bleeding. Among them, 218 patients received terlipressin, and 93 patients received somatostatin. The overall 30 day mortality rate was 13.2% (41/311). A total of 78 (25.1%) patients underwent second-look endoscopy, but only 12 (7%) needed a second course of gastric variceal sclerotherapy. The overall 30-day mortality rates for patients treated with terlipressin and somatostatin were 13.3% and 12.9%, respectively, showing no statistically significant differences between outcomes in the two treatment groups (P = 0.672). The risk of 30-day mortality was significantly higher in patients with hepatocellular carcinoma (HR: 3.257, 95% CI: 1.640-6.469, P= 0.001), acute renal failure (HR: 6.261, 95% CI: 2.376-16.499, P < 0.001), or hepatic encephalopathy (HR: 3.091, 95% CI: 1.430-6.680, P= 0.004).Conclusions:Mortality rates did not differ significantly between cirrhosis patients with acute gastric variceal bleeding who received somatostatin or terlipressin as adjuvants to endoscopy.

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Section: Discussionmentioning

confidence: 83%

“…Tissue adhesives including cyanoacrylate-based compounds have been used successfully for the treatment of GVs. [ 3 17 18 19 ] The initial hemostasis control rate for GV bleeding is >90%, and the rebleeding rate is around 22%-37%. [ 20 21 22 23 ] Following GVS, the average mortality rate of GV bleeding is approximately 10%-30%.…”

Section: Discussionmentioning

confidence: 99%

No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage

Hung

Tsai

TsenK

et al. 2016

Saudi J Gastroenterol

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“…NBCA was injected during endoscopy in 42 studies [ 10 , 11 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 61 ] and through a direct percutaneous approach for stomal varices in 1 study [ 60 ]. The types of NBCA glue used in the included studies were as follows: Histoacryl ® (B. Braun, Melsungen, Germany) was the most used NBCA glue (37 studies, 3282 patients, 94.2% of patients) [ 10 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ,…”

Section: Resultsmentioning

confidence: 99%

“…The most used NBCA-Lipiodol ® mixture ratio was 1:1 in 25 studies involving 2208 patients [ 10 , 21 , 22 , 23 , 24 , 27 , 30 , 31 , 32 , 33 , 35 , 36 , 38 , 41 , 43 , 48 , 50 , 51 , 52 , 53 , 57 , 58 , 59 , 61 ]. Other ratios were 1:1.4 in 4 studies (266 patients) [ 25 , 37 , 45 , 54 ], 1:1.6 in 7 studies (391 patients) [ 11 , 26 , 28 , 29 , 39 , 49 , 56 ], 1:1.8 in 2 studies (54 patients) [ 29 , 60 ], 1:1 or 1:1.6 in 1 study (21 patients) [ 47 ], 1:3 in 1 study (37 patients) [ 40 ], 2:1 in 1 study (97 patients) [ 34 ], and 2.3:1 in 1 study (17 patients) [ 46 ]. In 1 study, the ratio range was 1:1 to 1:1.5 (97 patients) [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Chevallier

Guillen

Comby³

et al. 2021

JCM

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We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from January 1980 to December 2019 and including patients who had injection of NBCA for variceal GIB. Two independent reviewers extracted and evaluated the data from eligible studies. Exclusion criteria were sample size <5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. NBCA was injected during endoscopy in 42 studies and through a direct percutaneous approach for stomal varices in 1 study. The study’s endpoints were: Technical success, 30-day rebleeding, and 30-day overall and major complications. The estimated overall rates were computed with 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. In total, 43 studies with 3484 patients were included. The technical success rate was 94.1% (95% CI: 91.6–96.1%), the 30-day rebleeding rate was 24.2% (18.9–29.9%), and 30-day overall and major complications occurred in 15.9% (11.2–21.3%) and 5.3% (3.3–7.8%) of patients, respectively. For treating variceal GIB, NBCA injection is a safe and effective method that demonstrates high technical success rate and very low major complication rate.

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“…One-session PARTO procedure was sufficient for treating both hemostasis and obliteration of GV in our 2 patients. A previous study indicated that 25% of patients experience re-bleeding after histoacryl sclerotherapy of active gastric variceal hemorrhage ( 27 ). Therefore, PARTO could be an alternative method for preventing recurrent hemorrhage in patients with active gastric variceal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage

Chang

Kim

et al. 2016

Korean J Radiol

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ObjectiveTo evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension.Materials and MethodsFrom May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure.ResultsTechnical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO.ConclusionPARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

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Management of bleeding gastric varices

Abstract: A single session of histoacryl sclerotherapy is effective in the majority of patients with active gastric variceal bleeding. Rebleeding was observed in one-fourth of patients, half of whom were controlled successfully by repeated histoacryl sclerotherapy.

Cited by 15 publications

References 32 publications

No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage

No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage

Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage

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