title: A randomized trial of endoscopic variceal ligation versus cyanoacrylate injection for treatment of bleeding junctional varices.
abstract: BACKGROUND
  There is scarcity of data concerning the management of bleeding junctional gastroesophageal varices.
  
  
  OBJECTIVE
  Our aim was to compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding junctional varices.
  
  
  METHODS
  One hundred fifty patients with bleeding junctional varices were included in the study. Patients were subjected after randomization to either EVL of junctional varices (group 1:75 patients) or cyanoacrylate injection (group 11:75 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients.
  
  
  RESULTS
  Control of active variceal bleeding was achieved in 61 patients (81%) in group I and in 68 patients (91%) in group II with no significant difference (p = 0.07). Re-bleeding was seen in 12 patients (16%) in group I and 5 patients in group II (6%). Junctional varix obliteration was achieved after one session in 33% of patients in group I and 52% of patients in group II, however after 2 sessions it was achieved in 67% in group I and 93 % in group II. After 3 sessions variceal obliteration was achieved in 99% in group 1. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I.
  
  
  CONCLUSIONS
  EVL may be a good alternative to cyanoacrylate injection in treatment of bleeding junctional varices.
authors.affiliation: Department of Internal Medicine, Assuit University, Cairo, Egypt.
authors.forename: H
authors.initials: H
authors.lastname: El Amin
authors.forename: L
authors.initials: L
authors.lastname: Abdel Baky
authors.forename: Z
authors.initials: Z
authors.lastname: Sayed
authors.forename: E
authors.initials: E
authors.lastname: Abdel Mohsen
authors.forename: K
authors.initials: K
authors.lastname: Eid
authors.forename: Y
authors.initials: Y
authors.lastname: Fouad
authors.forename: H
authors.initials: H
authors.lastname: El Khayat
mesh_terms: D000328:Adult; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003487:Cyanoacrylates