In:
American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S367-S367
Abstract:
Gastroesophageal variceal hemorrhage is an important complication from portal hypertension. Nearly 20% of this type of bleeding is from gastric varices (GVs), which is considered more profuse and severe compared to esophaeal variceal bleeding. There are many treatment modalities for GVs active bleeding. The use of tissue adhesives like cyanoacrylate is gaining acceptance for the treatment of GVs with a safe profile. The aim of this study is to determine the effectiveness of cyanoacrylate application in active GV bleeding. METHODS: We retrospectively reviewed the clinical data of 58 patients who underwent cyanoacrylate application in the setting of active GVs bleeding from January 2016 to July 2018. The outcomes of our study were initial hemostasis, inpatient bleeding, early rebleeding and 6-week mortality. The safety of the procedures was followed as well. RESULTS: A total of 75 procedures of cyanoacrylate injection were performed in 58 patients over a period of 3 years (January 2016-July 2018). Thirty-seven male patients (63.7%) with a mean age of 55.9 ± 13.8 years old were included. The mean duration of follow-up was 122 ± 2 days (range 1 to 719 days). From the total of patients enrolled, 32 (55.1%) and 11 (18.9%) were Child Pugh B and C, respectively. The main symptoms in these patients were hematemesis in 29 (50.0%), melena in 7 (12.0%), or both in 19 (32.7%). In the 58 patients evaluated, the different types of GVs were registered; many patients had more than one type of GVs according to Sarin´s classification. GV prevalence in our patients was GOV2 (43.1%), IGV1 (41.3%), GOV1 (22.4%) and IGV2 (10.3%). The success of the index endoscopic hemostatic procedure was 96.5%. A second endoscopy was performed in 58.6% of patients within 24 hours to assure complete blood vessel occlusion and no residual bleeding; a second cyanoacrylate injection was needed in 12% patients (20.6%). The inpatient and early rebleeding was 18.9% and 17.2%, respectively. The overall mortality was 18.9%. Adverse events were not detected in the current study. CONCLUSION: Cyanoacrylate injection is an effective therapeutic and safe option in acute GVs bleeding. We suggest an aggressive approach therapy in patients with active GVs bleeding, since it portends a higher incidence of recurrence; a second-look endoscopy, the use of endoscopic ultrasound and a thorough evaluation of rebleeding should be considered.
Type of Medium:
Online Resource
ISSN:
0002-9270
,
1572-0241
DOI:
10.14309/01.ajg.0000592060.70977.5e
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
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