Cyanoacrylate injection versus band ligation for bleeding from cardiac varices along the lesser curvature of the stomach.

Abstract

BACKGROUND/AIMS:

Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1.

METHODS:

Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded.

RESULTS:

The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001).

CONCLUSION:

Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1.

• Authors: Sang Jung Park, Yong Kwon Kim, Yeon Seok Seo, Seung Woon Park, Han Ah Lee, Tae Hyung Kim, Sang Jun Suh, Young Kul Jung, Ji Hoon Kim, Hyunggin An, Hyung Joon Yim, Jae Young Jang, Jong Eun Yeon, Kwan Soo Byun
• Journal: Clinical and molecular hepatology (Clin Mol Hepatol) Vol. 22 Issue 4 Pg. 487-494 (Dec 2016) ISSN: 2287-285X [Electronic] Korea (South)
• PMID: 28081588 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Cyanoacrylates

Topics

• Adult
• Aged
• Carcinoma, Hepatocellular (complications)
• Cyanoacrylates (therapeutic use)
• Disease-Free Survival
• Endoscopy, Gastrointestinal
• Female
• Gastrointestinal Hemorrhage (etiology, mortality, therapy)
• Humans
• Ligation
• Liver Cirrhosis (complications, diagnosis)
• Liver Neoplasms (complications)
• Male
• Middle Aged
• Proportional Hazards Models
• Recurrence
• Retrospective Studies
• Sclerotherapy
• Survival Rate
• Treatment Outcome