Long-term effect of endoscopic injection therapy with combined cyanoacrylate and ethanol for gastric fundal varices in relation to portal hemodynamics.
BACKGROUND
The understanding on the long-term effect of endoscopic therapy for gastric fundal varices (FV) is still insufficient. The aim of this study was to evaluate the relationship between the long-term effect of the endoscopic injection therapy with combined cyanoacrylate (CA) and absolute ethanol (ET) for FV, and the portal hemodynamics.


METHODS
The subjects of this retrospective study were ten consecutive cirrhotic patients with bleeding FV treated by endoscopic injection therapy with combined CA and ET. Percutaneous transhepatic portography was done after the completion of endoscopic treatment to assess portal hemodynamics.


RESULTS
All the patients showed hemostasis by CA injection and complete obturation of FV by combined therapy of 5.6 +/- 2.1 (3-9) times without any severe complications except for gastric ulcer in one case. Five patients had recurrence (50%), and three of them showed rebleeding (30%). The other five patients had no recurrence during a mean observation period of 5.58 years (1190-2735 days). Although recurrence did not correlate with portal venous pressure, it was significantly frequent in patients without advanced portosystemic collateral vessels (5/7, P = 0.0384) compared to patients with them (0/3).


CONCLUSIONS
Endoscopic injection therapy combining CA and ET may be effective for FV. Significant development of portosystemic collateral vessels would support long-term therapeutic effect after this treatment.
Maruyama
Hitoshi
H
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan. maru-cib@umin.ac.jp
Okabe
Shinichiro
S
Ishihara
Takeshi
T
Tsuyuguchi
Toshio
T
Yoshikawa
Masaharu
M
Matsutani
Shoichi
S
Yokosuka
Osamu
O
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005748:Gastric Fundus; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic; D006801:Humans; D015552:Injections, Intralesional; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology*; D011172:Portography; D012008:Recurrence; D012597:Sclerosing Solutions / Q000008:administration & dosage; D014014:Tissue Adhesives / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014690:Venous Pressure
D003287:Contrast Media; D003487:Cyanoacrylates; D012597:Sclerosing Solutions; D014014:Tissue Adhesives; D000431:Ethanol