A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL.
BACKGROUND
Endoscopic injection of N-butyl-2-cyanoacrylate is the preferred method to treat acute gastric variceal bleeding (GVB). However, its rebleeding rate remains high.


OBJECTIVE
To compare an injection containing 0.5 mL of cyanoacrylate (group A) with an injection containing 1.0 mL of cyanoacrylate (group B).


METHODS
A single-center, randomized, controlled trial.


METHODS
A tertiary referral center.


METHODS
Occurrence of rebleeding.


METHODS
Patients with acute gastric variceal bleeding.


RESULTS
Forty-four patients in group A and 47 patients in group B were studied; their clinical characteristics were similar. The treatment stopped active bleeding in approximately 90% of cases in both groups. The rebleeding rate was 29.8% (14/47) in group B compared with 38.6% (17/44) in group A (P = .504; 95% CI, -10.592 to 28.280). On multivariate analysis, concomitant hepatocellular carcinoma, infection, and the size of the gastric varices were independent determinants of rebleeding. More patients in group B than in group A had postinjection fever (>37.5 degrees C) (23/47 vs 12/44, P = .059). Treatment failure, complications, 30-day mortality, and survival did not differ between the 2 groups.


CONCLUSIONS
Due to the small number of study patients, a double dose of cyanoacrylate injection for GVB cannot be proven to have better hemostatic efficacy than a single dose. Multicenter studies with larger patient numbers are necessary to determine whether a double dose is in fact more efficacious.
Hou
Ming-Chih
MC
Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Taipei, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan 11217.
Lin
Han-Chieh
HC
Lee
Hai-Shin
HS
Liao
Wei-Chih
WC
Lee
Fa-Yauh
FY
Lee
Shou-Dong
SD
D000208:Acute Disease; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004659:Enbucrilate / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D005773:Gastroscopy; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D014014:Tissue Adhesives / Q000008:administration & dosage*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014014:Tissue Adhesives; D014662:Vasoconstrictor Agents; D004659:Enbucrilate