[Therapeutic effect of the endoscopic N-butyl-2-cyanoacrylate injection for acute esophagogastric variceal bleeding: comparison with transjugular intrahepatic portosystemic shunt].
OBJECTIVE
Though endoscopic therapies such as variceal ligation and sclerotherapy has been performed, bleeding from the large esophageal and gastric varices still poses significant risk of death. Decrease of portal pressure by TIPS (transjugular intrahepatic portosystemic shunt) or surgical shunt was indicated as cause of failure of endoscopic therapies. Treatment of N-butyl-2-cyanoacrylate has been especially effective for gastric variceal bleeding, but comparison with other treatments had not been reported yet. In this study, the effect of cyanoacrylate injection therapy was cross-examined with the result of TIPS in acute esophagogastric variceal bleedings.


METHODS
From April 1995 to June 2002, endoscopic cyanoacrylate injection therapy (43 cases) and TIPS (63 cases) were performed in our hospital. Each group was analysed regarding their clinical results including initial hemostasis rate, rebleeding rate, survival duration, mortality and morbidity.


RESULTS
Initial hemostasis rate was 95.3% in cyanoacrylate group and 92.1% in TIPS group. Cumulative probability of rebleeding was not different between two groups. Overall complication rates associated with the procedure were 50.8% in TIPS group and 9.3% in cyanoacrylate group. There was no significant difference between two groups in their survival rates.


CONCLUSIONS
Cyanoacrylate injection therapy was relatively safe, and has comparable results with TIPS for uncontrollable and severe esophagogastric variceal bleedings.
Noh
Du Young
DY
Department of Internal Medicine, Chonnam University College of Medicine, Don-gu, Gwangju, Korea.
Park
Sun Young
SY
Joo
So Young
SY
Park
Chang Hwan
CH
Lee
Wan Sik
WS
Joo
Young Eun
YE
Kim
Hyun Su
HS
Choi
Sung Kyu
SK
Rew
Jong Sun
JS
Kim
Sei Jong
SJ
D000208:Acute Disease; D004659:Enbucrilate / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000601:surgery / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D014014:Tissue Adhesives / Q000008:administration & dosage*
D014014:Tissue Adhesives; D004659:Enbucrilate