Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial.

Abstract

BACKGROUND & AIMS:

Gastric variceal bleeding is severe and is associated with high mortality. We compared the efficacy of cyanoacrylate injection and beta-blockers in primary prophylaxis of gastric variceal bleeding.

METHODS:

Cirrhotics with large gastroesophageal varices type 2 with eradicated esophageal varices or large isolated gastric varix type 1, who had never bled from gastric varix, were randomised to cyanoacrylate injection (Group I, n=30), beta-blockers (Group II, n=29) or no treatment (Group III, n=30). Primary end-points were bleeding from gastric varix or death.

RESULTS:

The actuarial probability of bleeding from gastric varices over a median follow-up of 26 months was 13% in Group I, 28% in Group II (p=0.039), and 45% in Group III (p=0.003). The actuarial probability of survival was higher in the cyanoacrylate compared to the no-treatment group (90% vs. 72%, p=0.048). The median hepatic venous pressure gradient (HVPG) was increased in Group I (14-15 mm Hg, p=0.001) and III (14-16 mm Hg, p=0.001) but decreased in Group II (14 to 12 mm Hg, p=0.001) during follow-up. Size of gastric varix >20 mm, a MELD score ≥17, and presence of portal hypertensive gastropathy predicted 'high risk' of first bleeding from gastric varices.

CONCLUSIONS:

Primary prophylaxis is recommended in patients with large and high risk gastric varices to reduce the risk of first bleeding and mortality. Cyanoacrylate injection is more effective than beta-blocker therapy in preventing first gastric variceal bleeding.

• Authors: Smruti Ranjan Mishra, Barjesh Chander Sharma, Ashish Kumar, Shiv Kumar Sarin
• Journal: Journal of hepatology (J Hepatol) Vol. 54 Issue 6 Pg. 1161-7 (Jun 2011) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 21145834 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Cyanoacrylates
• Propranolol

Topics

• Adolescent
• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Aged
• Child
• Cyanoacrylates (administration & dosage)
• Esophageal and Gastric Varices (drug therapy, pathology, physiopathology)
• Female
• Gastrointestinal Hemorrhage (prevention & control)
• Humans
• Injections, Intralesional
• Male
• Middle Aged
• Propranolol (therapeutic use)
• Venous Pressure
• Young Adult