[Effect of endoscopic sclerotherapy using N-butyl-2-cyanoacrylate in patients with gastric variceal bleeding].
OBJECTIVE
Gastric variceal bleeding is a severe complication of cirrhosis, and it has a high mortality rate. This study was conducted to evaluate the efficacy of n-butyl-2-cyanoacrylate injection therapy for patients suffering with gastric variceal bleeding.


METHODS
A total of 86 patients diagnosed with gastric variceal bleeding underwent endoscopic n-butyl-2-cyanoacrylate (Histoacryl) injection therapy at our department between April, 2002 and July, 2005, with a mean follow-up period of 44 weeks (range: 2 to 136 weeks). The initial hemostasis rate and the rebleeding rate of endoscopic sclerotherapy were analyzed. Also, the cumulative survival rate was analyzed according to the status of hepatocellular carcinoma and hyponatremia, the MELD score, the Child-Pugh score and the amount of injected Histoacryl.


RESULTS
The initial hemostasis rate of Histoacryl injection therapy was 93% and the 1 month rebleeding rate was 16.1%. The total number of session for treating the initial hemostasis was 1.2+/-0.4 and the total volume of Histoacryl was 2.7+/-1.2 mL. The cumulative rebleeding-free rates for the patients treated by the Histoacryl injection method at 1 month, 12 months and 34 months period were 95.1%, 83.2% and 74%, respectively. The cumulative survival rates were 78.3% at 1 month, 61.9% at 12 months and 54.6% at 34 months, respectively. No thromboembolic phenomenon occurred. According to the Cox's proportional hazards analysis, only the MELD score (<15) was an independent predicting factor for survival of the patients with gastric variceal bleeding.


CONCLUSIONS
Endoscopic sclerotherapy using n-butyl-2-cyanoacrylate was a safe and effective hemostatic method for patients with gastric variceal bleeding. Also, the MELD score (<15) contributed to predicting survival of the patients with gastric variceal bleeding.
Kim
Jae Woo
JW
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Baik
Soon Koo
SK
Kim
Kyu Hong
KH
Kim
Hye Jeong
HJ
Jo
Ki Won
KW
Hong
Jin Hon
JH
Jee
Myeong Gwan
MG
Kim
Hyun Soo
HS
Kwon
Sang Ok
SO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004659:Enbucrilate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D015911:Sclerotherapy; D015996:Survival Rate; D016896:Treatment Outcome
D004659:Enbucrilate