Abstract | BACKGROUND AND STUDY AIMS: Both endoscopic obturation and transjugular intrahepatic portosystemic shunts ( TIPSs) have proven to be effective in preventing rebleeding from gastric varices. This study compared the efficacy and complications of these modalities. PATIENTS AND METHODS: Cirrhotic patients with acute bleeding from gastric varices were considered for inclusion. After initial control, eligible patients were randomly allocated to two groups: TIPS (n = 35) and obturation using cyanoacrylate (n = 37). In the cyanoacrylate group, treatment was repeated regularly until gastric varices were obliterated. Patients of both groups received regular follow-up. The end points were gastric variceal rebleeding or death. RESULTS:
Stent shunt insertion was successful in all TIPS patients, and mean portal pressure gradient decreased from 21.4 +/- 7.5 mm Hg to 7.5 +/- 3.5 mm Hg ( P < 0.001). Variceal obliteration was achieved in 19 patients in the cyanoacrylate group (51 %) compared with seven TIPS patients (20 %) ( P < 0.02). After a median follow up of 33 months, upper gastrointestinal bleeding occurred in 15 TIPS patients (43 %) and 22 cyanoacrylate patients (59 %) ( P = 0.12). Rebleeding from gastric varices was encountered in four TIPS patients (11 %) and 14 cyanoacrylate patients (38 %) ( P = 0.014; odds ratio 3.6, 95 %CI 1.2 - 11.1). Blood transfusion requirements were lower in the TIPS group than in the cyanoacrylate group ( P < 0.01). Survival and frequency of complications were similar in both groups. CONCLUSIONS:
TIPS proved more effective than glue injection in preventing rebleeding from gastric varices, with similar survival and frequency of complications.
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Authors | G-H Lo, H-L Liang, W-C Chen, M-H Chen, K-H Lai, P-I Hsu, C-K Lin, H-H Chan, H-B Pan |
Journal | Endoscopy
(Endoscopy)
Vol. 39
Issue 8
Pg. 679-85
(Aug 2007)
ISSN: 1438-8812 [Electronic] Germany |
PMID | 17661241
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Adult
- Age Factors
- Aged
- Cyanoacrylates
(therapeutic use)
- Esophageal and Gastric Varices
(complications, diagnosis)
- Female
- Follow-Up Studies
- Gastrointestinal Hemorrhage
(etiology, mortality, prevention & control)
- Humans
- Male
- Middle Aged
- Portasystemic Shunt, Transjugular Intrahepatic
(methods)
- Probability
- Prospective Studies
- Risk Assessment
- Sclerotherapy
(methods)
- Secondary Prevention
- Sensitivity and Specificity
- Severity of Illness Index
- Sex Factors
- Survival Analysis
- Treatment Outcome
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