Patients who presented to the Siriraj Gastrointestinal Endoscopy Center with active gastric variceal
bleeding and were admitted for treatment between April 2008 and October 2011 were selected retrospectively for study inclusion. All
bleeding varices were treated by injection of Histoacryl® tissue glue (B. Braun Melsungen AG, Germany) through a 21G or 23G
catheter primed with
lipiodol to prevent premature glue solidification. Data recorded for each patient included demographic and clinical characteristics, endoscopic findings, clinical outcomes in terms of early and late re-
bleeding, mortality, and procedure-related complications. Data from admission (baseline) and post-treatment were comparatively analyzed using stepwise logistic regression analysis to determine the correlation between factors and clinical outcomes.
RESULTS: A total of 90 patients underwent Histoacryl® injection to treat
bleeding gastric varices. The mean age was 55.9 ± 13.9 (range: 15-88) years old, and 74.4% of the patients were male. The most common presentations were
hematemesis (71.1%),
melena (12.2%), and
coffee ground
emesis (8.9%). Initial hemostasis was experienced in 97.8% of patients, while re-
bleeding within 120 h occurred in 10.0%. The presence of
ascites was the only factor associated with early and late re-
bleeding [odds ratio (OR) = 10.67, 95%CI: 1.27-89.52, P = 0.03 and OR = 4.15, 95%CI: 1.34-12.86, P = 0.01, respectively]. Early procedure-related complications developed in 14.4% of patients, and were primarily
infections and non-fatal systemic embolization. Late re-
bleeding was significantly correlated with early procedure-related complications by univariate analysis (OR = 4.01, 95%CI: 1.25-12.87, P = 0.04), but no factors were significantly correlated by multivariate analysis. The overall mortality rate was 21.1%, the majority of which were related to
infections. The factors showing strong association with higher mortality risk were elevated total
bilirubin (OR = 16.71, 95%CI: 3.28-85.09, P < 0.01), a large amount of transfused fresh frozen plasma (OR = 1.001, 95%CI: 1.000-1.002, P = 0.03), and late re-
bleeding (OR = 10.99, 95%CI: 2.15-56.35, P = 0.02).
CONCLUSION: Histoacryl® injection is a safe and effective
hemostatic method for treating gastric variceal
hemorrhage. Patients with compromised liver, including
ascites, have a higher risk of re-
bleeding.