title: The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome.
abstract: BACKGROUND
  Cyanoacrylate has been recommended for the treatment of gastric variceal bleeding.
  
  
  OBJECTIVE
  We aimed to evaluate the efficacy and safety of cyanoacrylate injection therapy in patients with gastric variceal bleeding, and to identify the factors predictive of failure, rebleeding, and survival after therapy.
  
  
  METHODS
  One hundred twenty-one patients with gastric variceal bleeding who received cyanoacrylate injections were retrospectively reviewed.
  
  
  RESULTS
  Treatment succeeded in 110 patients (90.9%). Rebleeding and mortality rate during 4-week were 13.2% and 11.6%. A stepwise logistic regression analysis indicated that only the Child-Pugh class was an independent predictive factor of treatment failure [Child-Pugh C vs. Child-Pugh A and B, odds ratio (OR), 5.0; 95% confidence interval (CI), 1.2-19.4; P=0.025]. The actuarial probability of a 4-week absence of rebleeding and survival after the initial therapy was 86.8% and 85.1%, respectively. A stepwise logistic regression analysis showed that a Child-Pugh class C and hepatocellular carcinoma were independent predictive factors for rebleeding (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively) and mortality (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively). Only 2 cases (2.7%) with serious complications, noted as cyanoacrylate embolisms, were observed. At 1-year follow up, the actuarial probability of remaining free of bleeding was 49.0% and hepatitis B virus infection was independent predictive factor of bleeding (OR, 5.3; 95% CI, 1.4-20.0; P=0.015).
  
  
  CONCLUSIONS
  In short-term follow-up, cyanoacrylate injection is an effective treatment method for gastric variceal bleeding and the Child-Pugh class was only independent predictive factor of treatment failure and the Child-Pugh class and the hepatocellular carcinoma were risk factors for rebleeding and survival. In long-term follow-up, the presence of hepatitis B infection was risk factor for rebleeding.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Chang Nyol
authors.initials: CN
authors.lastname: Paik
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Myung Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: In Sik
authors.initials: IS
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications; D003487:Cyanoacrylates / Q000009:adverse effects / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011655:Pulmonary Embolism / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D003487:Cyanoacrylates