The safety and probable therapeutic effect of routine use of antibiotics and simultaneously treating bleeding gastric varices by using endoscopic cyanoacrylate injection and concomitant esophageal varices with banding ligation: a pilot study.
BACKGROUND
Gastroesophageal varices are the most common type of gastric varices. Although endoscopic injection of N-butyl-2-cyanoacrylate is the current treatment of choice for acute gastric variceal bleeding, whether the concomitant esophageal varices should be ligated simultaneously with the first treatment session is currently not known.


OBJECTIVE
The aim of this study was to evaluate the safety and probable therapeutic effect of simultaneous cyanoacrylate injection for bleeding gastric varices obliteration (GVO) and endoscopic band ligation (EBL) for concomitant esophageal varices in combination with routine antibiotics (simultaneous group), and to compare our results with historical results in which the patients underwent GVO first and then EBL for concomitant esophageal varices (separate group).


METHODS
A single-center pilot study.


METHODS
A tertiary referral center.


METHODS
Patients with liver cirrhosis and gastroesophageal varices, who presented with acute gastric varices bleeding.


METHODS
Simultaneous treatment in the form of GVO and EBL for concomitant esophageal varices in combination with routine antibiotics.


METHODS
Rebleeding and mortality within the first year of index bleeding.


RESULTS
Twenty patients in the simultaneous group and 67 patients in the separate group were included in the study. The 2 groups had similar baseline characteristics. The hemostasis of active bleeding was 100% in both groups (7/7 vs 20/20). The 1-year rebleeding rate was 10% (2/20) in the simultaneous group and 37.31% (25/67) in the separate group (P = .041). Kaplan-Meier analysis showed higher probability of remaining free of rebleeding in the simultaneous group (88.5% vs 61.1%; P = .044). Multivariate analysis indicated that treatment method (separate group) and high model for end-stage liver disease score (> or = 13) were independent risk factors of rebleeding in 1 year. The treatment failure, complications, 1-year mortality, and survival were similar in both groups.


CONCLUSIONS
Simultaneous endoscopic treatment for gastric varices bleeding and concomitant esophageal varices is a safe and effective procedure in combination with antibiotic prophylaxis for patients with cirrhosis. The 1-year mortality rate was similar between the 2 groups. The results need further validation.
Chang
Chen-Jung
CJ
Current affiliations: National Yang-Ming University School of Medicine and Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 11217.
Hou
Ming-Chih
MC
Lin
Han-Chieh
HC
Lee
Hai-Shin
HS
Liao
Wei-Chih
WC
Su
Chien-Wei
CW
Lee
Shou-Dong
SD
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004659:Enbucrilate / Q000008:administration & dosage*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D015552:Injections, Intralesional; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D055502:Secondary Prevention; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004659:Enbucrilate