Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate.
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.
Sugimoto
Nozomi
N
Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
Watanabe
Kenichiro
K
Watanabe
Kazuyo
K
Ogata
Shinichi
S
Shimoda
Ryo
R
Sakata
Hiroyuki
H
Eguchi
Yuichiro
Y
Mizuta
Toshihiko
T
Tsunada
Seiji
S
Iwakiri
Ryuichi
R
Nojiri
Junichi
J
Mizuguchi
Masanobu
M
Kudo
Sho
S
Miyazaki
Kohji
K
Fujimoto
Kazuma
K
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
D012597:Sclerosing Solutions; D004659:Enbucrilate