title: Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate.
abstract: BACKGROUND
  Bleeding from esophagogastric varices is a serious complication of portal hypertension. The aim of the present study was to determine whether endoscopic sclerotherapy with injection of N-butyl-2-cyanoacrylate combined with variceal ligation was useful for hemostasis of bleeding gastric varices.
  
  
  METHODS
  Twenty-seven patients with bleeding gastric varices underwent endoscopic treatment with variceal ligation followed by sclerotherapy with N-butyl-2-cyanoacrylate from November 1995 to November 2000. Patients underwent endoscopic variceal ligation only for the bleeding spot just before sclerotherapy. Injection was continued until varices were engorged. After these therapies, patients were followed for at least for 5 years. Retreatment was applied as necessary.
  
  
  RESULTS
  Among these patients, 11 had active bleeding and 16 had recent bleeding within 24 h with white or red plaques on gastric varices. All varices presented as nodular or tumorous forms. The hemostasis rate at 1 week after treatment with N-butyl-2-cyanoacrylate was 88.9% (24/27). Among the patients achieving hemostasis at 1 week, 33.3% (8/24) experienced recurrent bleeding between 5 and 53 months after the initial treatment. Five patients with rebleeding were treated with N-butyl-2-cyanoacrylate, and the other three patients were treated by other procedures. The final hemostasis rate was 81.5% (22/27). The 5-year survival rate after initial hemostasis was 63.0% (17/27).
  
  
  CONCLUSIONS
  This study showed that endoscopic variceal ligation combined with sclerotherapy might become a recommended choice for effective treatment of bleeding gastric varices.
authors.affiliation: Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Sugimoto
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Watanabe
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ogata
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimoda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakata
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mizuta
authors.forename: Seiji
authors.initials: S
authors.lastname: Tsunada
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Iwakiri
authors.forename: Junichi
authors.initials: J
authors.lastname: Nojiri
authors.forename: Masanobu
authors.initials: M
authors.lastname: Mizuguchi
authors.forename: Sho
authors.initials: S
authors.lastname: Kudo
authors.forename: Kohji
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004659:Enbucrilate / Q000627:therapeutic use*; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy
chemical_list: D012597:Sclerosing Solutions; D004659:Enbucrilate