Korean J Intern Med.  2014 Jul;29(4):437-444.

Clinical outcomes of gastric variceal obliteration using N-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

• Jun CH
• Kim KR
• Yoon JH
• Koh HR
• Choi WS
• Cho KM
• Lim SU
• Park CH
• Joo YE
• Kim HS
• Choi SK
• Rew JS

Abstract

BACKGROUND/AIMS
To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices.
METHODS
We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients' endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding-related death rates were reviewed.
RESULTS
Hemostasis was achieved initially in 96.9% (441/455) of patients; rebleeding occurred in 35.2% (160/455), and the bleeding-related death rate was 6.8% (31/455) during follow-up. Complications included fever (6.8%), abdominal pain (3.7%), diarrhea (1.3%), spontaneous bacterial peritonitis (0.7%), bacteremia (0.4%), and embolism (0.2%). A red-color sign on concomitant esophageal varices (EVs) (p = 0.002) and previous history of variceal bleeding (p < 0.001) were significant risk factors for rebleeding within 1 year. The Child-Pugh score (p < 0.001), presence of hepatocellular carcinoma (p = 0.001), and failure of initial hemostasis (p < 0.001) were the risk factors most closely associated with bleeding-related death.
CONCLUSIONS
This study provides a comprehensive overview of the outcomes and prognostic factors of patients with GVH. The results may help in the selection of effective treatment strategies for patients with GVH.

Keyword

Esophageal and gastric varices; Cyanoacrylates; Hemostasis; Endoscopy; Treatment outcome

MeSH Terms

Adult
Aged
Aged, 80 and over
Enbucrilate/adverse effects/*therapeutic use
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/complications/diagnosis/mortality/*therapy
Female
Gastrointestinal Hemorrhage/diagnosis/etiology/mortality/*therapy
*Hemostatic Techniques/adverse effects/mortality
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Enbucrilate