Document Type

Article

Department

Medicine

Abstract

Aim: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV).

Methods: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.

Results: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV-Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P < 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).

Conclusion: GV can be seen in 15% of patients with f patients with using the tissue adhesive agent butyl cyanoacrylate. Since then several authors have used different sclerosing agents to achieve hemostasis in bleeding gastric varices, including N-butyl-2 cyanoacrylate (histoacryl)[4,8], 2-octyl cyanoacrylate[9], ethanolamine oleate injection[10], gastric variceal banding[11], thrombin[12], sodium tetradecyl sulfate[13]. However, N-butyl 2 cyanoacrylate (NBC) is the only promising agent. Most reports on endoscopic treatment of bleeding gastric varices are small series, case reports, or retrospective reviews[14,15]. Not more than 1000 patients with bleeding GV have been treated with different sclerosing and coagulating agents. Cyanoacrylate injection can achieve primary hemostasis in 70% to 95% of patients with acute GV bleeding, with an early rebleeding rate ranging from 0% to 28% within 48 h[5,7,16]. Different doses of cyanoacrylate are used by different gastroenterologis ts[16,17]. Moreover, dilution ratio of NBC to lipoidal is different[18,19]. However, there is no consensus regarding effective dose and dilution of sclerosing agents. This study was to analyze patients with GV in order to establish predictors of bleeding GV, and the efficacy and safety of NBC in treatment of bleeding GV.

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Publication

World journal of gastroenterology.

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