Endoscopic histoacryl obliteration vs. propranolol in the prevention of esophagogastric variceal rebleeding: a randomized trial.
OBJECTIVE
The obliteration of esophageal and/or gastric varices using Histoacryl is highly effective in controlling active bleeding. However, it is not known whether repeated injections are useful for the long-term eradication of esophagogastric varices. The aim of the study was to compare endoscopic Histoacryl obliteration with propranolol in the secondary prevention of esophagogastric variceal bleeding.


METHODS
Between August 1995 and February 1999, 41 patients with a first bleeding from esophageal (n = 31) or gastric (n = 10) varices were included in the study. After primary hemostasis with obliteration using Histoacryl, patients were randomly allocated either to undergo complete Histoacryl obliteration of the remaining varices (group A, n = 21) or to long-term propranolol administration (group B, n = 20), for the prevention of rebleeding.


RESULTS
The two groups were well matched for age, sex, etiology of cirrhosis, Child-Pugh score, renal function, and infection at the time of admission. The median follow-up was 31.9 months (4.8 - 74.7) for group A and 23.2 months (3.0 - 70.0) for group B. Initial hemostasis was achieved in 40/41 patients (97 %). No significant difference was observed between groups A and B with regard to the incidence of early rebleeding (during the first 6 weeks; 5/21 and 3/20), bleeding-related deaths by 6 weeks (3/21 and 6/20), long-term rebleeding (11/21 and 5/20), or overall number of deaths (9/21 and 9/20). The incidence of complications was higher in group A (10/21) than group B (2/20) (P < 0.03).


CONCLUSIONS
Repeated injections of Histoacryl with the aim of eradicating esophagogastric varices are associated with more complications compared with beta-blocker administration, with similar results in terms of rebleeding rate and survival in the long term.
Evrard
S
S
Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
Dumonceau
J-M
JM
Delhaye
M
M
Golstein
P
P
Devière
J
J
Le Moine
O
O
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004659:Enbucrilate / Q000008:administration & dosage*; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D012008:Recurrence; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D014014:Tissue Adhesives; D011433:Propranolol; D004659:Enbucrilate