Korean J Hepatol.
1999 Dec;5(4):306-313.
N-utyl--yanoacrylate (Histoacryl) in the Treatment of Esophageal Variceal Bleeding: Comparison with Band Ligation
Abstract
- BACKGROUND/AIMS
Endoscopic sclerotherapy and band ligation have been well
documented beneficial therapeutic options of esophageal variceal bleeding. But acute
variceal bleeding is refractory to sclerotherapy in upto one-hird of patients,
and rebleeding occurs in 30% to 50%. Recently alternative endoscopic modality,
N-utyl--yanoacrylate (Histoacryl) injection is performed in intravariceal sclerotherapy
but its efficacy and safty are not clearly established. We evaluated the efficacy of
Histoacryl on esophageal variceal bleeding and compared with that of endoscopic band
ligation in the present study.
MATERIALS/METHODS
From March 1994 to March 1998,
ninety seven patients with endoscopically documented esophageal variceal bleeding
were enrolled. Histoacryl injection (Histoacryl group, n=33) or endoscopic band ligation
(EVL group, n=64) was done for esophageal variceal bleeding. We evaluated the rebleeding
rate and in-ospital mortality in both groups.
RESULTS
Baseline characteristics were
similar but active bleeding on first endoscopic session was significantly higher
in Histoacryl group (Histoacryl group; 90.7%, EVL group; 26.6%, p=0.002).
Successful hemostasis was done at 87.9% in Histoacryl group, 95.3% in EVL group
(not significant). There were no significant differences on early rebleeding rate
(18.2% vs 23.4%), late rebleeding rate (39.4% vs 37.5%) and in-ospital mortality
(24.2% vs 15.6%) between Histoacryl group and EVL group. There were no technique-elated
fatal complications at Histoacryl injection group.
CONCLUSION
Therapeutic efficacy of
Histoacryl injection was similar to the endoscopic band ligation in patients with esophageal
varix bleeding in terms of hemostasis and rebleeding. Histoacryl is effective therapeutic
option for esophageal variceal bleeding as well as gastric variceal bleeding.