title: Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding.
abstract: OBJECTIVE
  To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV).
  
  
  METHODS
  We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophago-gastro-duodenoscopy) and in-hospital mortality were analyzed.
  
  
  RESULTS
  The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-I) in 16 (32%), and GOV on greater curvature (GOV-II) in 15 (30%). IGV-I was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P < 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).
  
  
  CONCLUSIONS
  GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding. In hospital mortality of patients with bleeding GV is 6%.
authors: Section of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan.
authors: Khalid
authors: K
authors: Mumtaz
authors: Shahid
authors: S
authors: Majid
authors: Hasnain
authors: H
authors: Shah
authors: Kashif
authors: K
authors: Hameed
authors: Ashfaq
authors: A
authors: Ahmed
authors: Saeed
authors: S
authors: Hamid
authors: Wasim
authors: W
authors: Jafri
mesh_terms: D000328:Adult; D004659:Enbucrilate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate