Long-term outcomes of prophylactic endoscopic histoacryl injection for gastric varices with a high risk of bleeding.
OBJECTIVE
Endoscopic histoacryl injection (EHI) is reported to be an effective treatment modality for bleeding gastric varices (GVs) but controversial as a prophylactic treatment for non-bleeding GVs because efficacy and safety have yet to be determined. The aim of this study was to evaluate safety and long-term outcomes of prophylactic EHI for non-bleeding GVs with a high risk of bleeding.


METHODS
Thirty-three patients (23 males/10 females, mean age 56.6 years old) with a high risk of gastric variceal bleeding (large tumorous (27), red color sign (14) or rapidly growing in size (1)) underwent EHI. According to the grade of GVs, 25 patients belonged to F3, seven to F2, and one to F1. In terms of the locations of GVs, four patients belonged to type IGV1, 21 to type GOV2, and eight to type GOV1.


RESULTS
Obliteration of GVs was achieved in all of the treated patients. Twenty-three patients required one session and ten needed more than two sessions to obliterate their GVs. A mean volume of histoacryl used per session was 2.0 ml. Complications related to the procedure included immediate bleeding in two patients and bacteremia in one patient. The mean duration of follow-up was 12.2 months and eradication of GVs was achieved in 21 (95%) of 22 patients who were followed-up more than 3 months. Index GVs recurred in three of 21 patients (14%) and re-bleeding in index GVs after EHI occurred in two of 26 patients (8%).


CONCLUSIONS
Prophylactic EHI can be a promising procedure for eradication of non-bleeding GVs in case with a high risk of bleeding.
Chang
Yun Jung
YJ
Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Park
Jong-Jae
JJ
Joo
Moon Kyung
MK
Lee
Beom Jae
BJ
Yun
Jae-Won
JW
Yoon
Dae-Woong
DW
Kim
Ji Hoon
JH
Yeon
Jong Eun
JE
Kim
Jae Seon
JS
Byun
Kwan Soo
KS
Bak
Young-Tae
YT
D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000008:administration & dosage* / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use
D012597:Sclerosing Solutions; D004659:Enbucrilate