Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration.
OBJECTIVE
Our study aimed to evaluate the therapeutic results of endoscopic N-butyl-2-cyanoacrylate injection (EBC) and balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric variceal hemorrhage (GVH) and/or high-risk gastric varices (GV).


METHODS
Twenty-seven patients with GVH and/or high-risk GV (>or= 5 mm in diameter, those with red spots, and a Child-Pugh grading of B or C liver cirrhosis) who were treated with either EBC or BRTO from April 2005 to December 2007 were included in our study.


RESULTS
EBC or BRTO was initially used for the treatment of GVH in 14 and 13 patients, respectively. Technical success was achieved in all 14 patients (100%) initially treated with EBC, and 10 of 13 patients (76.9%) initially treated with BRTO. Significant rebleeding occurred in 10 patients (71.4%) of the EBC group, and two patients (15.4%) of BRTO group (P < 0.01). Five of six patients (83.3%) treated with rescue BRTO due to rebleeding after initial EBC achieved technical success, and all six patients who were treated with rescue BRTO had no rebleeding during the median follow up of 17 (range: 2-37) months. The cumulative survival rate of the EBC with the BRTO rescue group/BRTO group was significantly higher than the EBC group.


CONCLUSIONS
The therapeutic efficacies of EBC and BRTO for the treatment of active GVH and/or high-risk GV appeared to be similar. However, EBC might be associated with a higher rebleeding rate than BRTO. BRTO could be an effective rescue treatment for patients with GVH after initial treatment of EBC.
Hong
Cheul Ho
CH
Department of Internal Medicine, Sungkyunkwan University, Seoul, Korea.
Kim
Hong Joo
HJ
Park
Jung Ho
JH
Park
Dong Il
DI
Cho
Yong Kyun
YK
Sohn
Chong Il
CI
Jeon
Woo Kyu
WK
Kim
Byung Ik
BI
Hong
Hyun Pyo
HP
Shin
Jun Ho
JH
D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D015552:Injections, Intralesional; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D013997:Time Factors; D014014:Tissue Adhesives / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D009829:Oleic Acids; D012597:Sclerosing Solutions; D014014:Tissue Adhesives; D004659:Enbucrilate; C033343:ethanolamine oleate