Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study.
OBJECTIVE
Sclerotherapy may be useful in patients with bleeding gastric varices. The aim of this study was to compare the effects of two sclerosants in these patients.


METHODS
In a prospective nonrandomized trial, we performed single sclerotherapy for bleeding gastric varices using ethanolamine oleate (n = 24) or butyl cyanoacrylate (n = 29). The patients were followed for a mean of 14 months.


RESULTS
The rate of initial hemostasis (no bleeding occurred for 48 hours after sclerotherapy) was significantly higher in the butyl cyanoacrylate group (93%) than in the ethanolamine oleate group (67%) (p = 0.014). The rate of initial hemostasis in cardiac variceal bleeding did not differ significantly between the ethanolamine oleate and butyl cyanoacrylate groups (83% vs. 100%, p = 0.140). In contrast, the hemostasis rate for fundal variceal bleeding was significantly higher in the butyl cyanoacrylate group than in the ethanolamine oleate group (88% vs. 50%, p = 0.023). Although the rebleeding rate did not differ between the two groups (30% vs. 25%, p = 0.921), the mortality rate was significantly higher in the ethanolamine oleate group (67% vs. 38%, p = 0.043). In addition, the incidence of complications in the butyl cyanoacrylate group was similar to that in the ethanolamine oleate group (46% vs. 41%, p = 0.745).


CONCLUSIONS
These results suggest that initial control of fundal varices is more difficult than it is with cardiac varices, but butyl cyanoacrylate is superior to ethanolamine oleate, and the survival advantage from butyl cyanoacrylate seems to be partially related to the increased early bleeding deaths in the ethanolamine oleate group.
Oho
K
K
Department of Medicine II, Kurume University School of Medicine, Japan.
Iwao
T
T
Sumino
M
M
Toyonaga
A
A
Tanikawa
K
K
D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000627:therapeutic use*; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy; D015996:Survival Rate; D016896:Treatment Outcome
D009829:Oleic Acids; D012597:Sclerosing Solutions; D004659:Enbucrilate; C033343:ethanolamine oleate