Long-term Outcomes of Acute Gastric Variceal Bleeding in 48 Patients Following Treatment with Cyanoacrylate

• Published in: Digestive diseases and sciences Vol. 53; no. 2; pp. 544 - 550
• Main Authors: Marques, Petruska, Maluf-Filho, Fauze, Kumar, Atul, Matuguma, Sergio E., Sakai, Paulo, Ishioka, Shinichi
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2008; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biochemistry; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Enbucrilate - analogs & derivatives; Enbucrilate - therapeutic use; Esophageal and Gastric Varices - drug therapy; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - physiopathology; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - drug therapy; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - physiopathology; Hemostasis, Endoscopic; Hepatology; Humans; Liver - physiopathology; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Paper; Other diseases. Semiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tissue Adhesives - therapeutic use; Transplant Surgery; Treatment Outcome; Cyanoacrylate; Endoscopic hemostasis; Gastric varices (GV); Hemorrhage; Outcomes; Human; Stomach; Prognosis; Acute; Cardiovascular disease; Long term; Venous disease; Gastric varices; Vascular disease; Treatment; Hemostasis; Endoscopy; Varix
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-007-9882-5

Objectives (1) Study the effectiveness of intravariceal injection of n -butyl-2-cyanoacrylate to treat acute gastric variceal (GV) bleeding and (2) study the impact of the type of GV and hepatic function on endoscopic hemostasis and mortality outcomes. Methods Fourty-eight patients with acute GV bleeding underwent intravariceal injection of n -butyl-2-cyanoacrylate and were followed until death or study conclusion (12–52 months). Results Primary hemostasis (no re-bleeding within 48 h) was accomplished in 42 patients (87.5%). Appearance of the bleeding site at the time of initial endoscopy, grade of cirrhosis and location of GV were not significant predictors of immediate hemostasis. Early re-bleeding (48 h to 6 weeks) occurred in 20.5% of patients and late re-bleeding (beyond 6 weeks) in 20.5% of patients. While the Child-Pugh score was predictive of re-bleeding and mortality, the type of GV and stigmata at initial endoscopy were not significant predictors of re-bleeding and mortality. Over a mean follow-up of 18 months, mortality rates were 43.9% and bleeding was the commonest cause of death. Conclusion Endoscopic injection of n -butyl-2-cyanoacrylate is effective and safe for treating bleeding GV. Patients with poor hepatic function are at higher risk of re-bleeding and death after acute gastric variceal bleed.