title: A randomized-controlled trial of endoscopic treatment of acute esophageal variceal hemorrhage: N-butyl-2-cyanoacrylate injection vs. variceal ligation.
abstract: OBJECTIVE
  This prospective randomized trial compares the efficacy of N-butyl-2-cyanoacrylate injection and variceal ligation in emergency endoscopic treatment of acute esophageal variceal hemorrhage in patients with portal hypertension and chronic liver disease.
  
  
  METHODS
  Between January 2004 to December 2008 43 patients with endoscopy-proven acute esophageal variceal hemorrhage were randomly assigned to one of the two treatment groups: endoscopic injection with N-butyl-2-cyanacrylate (n=22) and endoscopic variceal ligation (n=21). Vital signs, the amount of blood transfusion and infection status were recorded before and after endoscopic treatment. Within two weeks after initial endoscopic treatment, prophylactic variceal ligation was performed until the varices were eradicated.
  
  
  RESULTS
  Success in arresting acute bleeding was no different in either group. The re-bleeding rate was higher in the cyanoacrylate group than the ligation group (13.6% us. 4.7%), with no statistical difference (p=0.60692). The mean amount of blood transfused was similar in both groups. Ten (45.5%) patients in the cyanoacrylate group and 7 (33%) in the ligation group died during an observational period of 14.1 +/- 13.9 months and 21.0 +/- 17.2 months, respectively (p=0.3272).
  
  
  CONCLUSIONS
  The efficacy of endoscopic injection therapy with N-butyl-2-cyanoacrylate to control acute esophageal variceal hemorrhage showed no difference to endoscopic variceal ligation nor did the esophageal variceal re-bleeding rate and mortality rate.
authors.affiliation: Interventional Gastroenterology Unit, Division of Gastroenterology, Department of Internal Medicine, Medical and Dental School University of Zagreb, "Sestre milosrdnice" Clinical Hospital, Zagreb, Croatia. ljubicic@kbsm.hr
authors.forename: Neven
authors.initials: N
authors.lastname: Ljubicić
authors.forename: Alen
authors.initials: A
authors.lastname: Bisćanin
authors.forename: Marko
authors.initials: M
authors.lastname: Nikolić
authors.forename: Vladimir
authors.initials: V
authors.lastname: Supanc
authors.forename: Davor
authors.initials: D
authors.lastname: Hrabar
authors.forename: Tajana
authors.initials: T
authors.lastname: Pavić
authors.forename: Marko
authors.initials: M
authors.lastname: Boban
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004659:Enbucrilate / Q000008:administration & dosage*; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007267:Injections; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D004659:Enbucrilate