title: Modified percutaneous transhepatic variceal embolization with 2-octylcyanoacrylate for bleeding gastric varices: long-term follow-up outcomes.
abstract: OBJECTIVE
  The objective of our study was to evaluate the long-term efficacy and safety of a modified percutaneous transhepatic variceal embolization procedure with 2-octylcyanoacrylate (2-OCA) in the treatment of gastric variceal bleeding.
  
  
  METHODS
  From January 2003 to December 2008, 71 patients with a history of gastric variceal bleeding underwent modified percutaneous transhepatic variceal embolization with 2-OCA in our hospital: 12 patients with acute gastric variceal bleeding underwent emergency obliteration and the remaining 59 patients with recent variceal bleeding underwent modified percutaneous transhepatic variceal embolization as a secondary prophylaxis. The initial hemostasis rate, rebleeding rate, survival rate, and complications were evaluated.
  
  
  RESULTS
  Complete obliteration--that is, all the gastric varices and their feeding veins were obliterated--was achieved after the percutaneous transhepatic variceal embolization procedure in 67 patients (94.4%). Acute variceal bleeding was arrested after the procedure in all 12 patients (100%). The mean follow-up period was 24.2 ± 12.4 (SD) months (range, 6-62 months). During the follow-up period, the cumulative probability of remaining free of gastric variceal rebleeding in patients with complete obliteration was 100%, 88.2%, and 88.2% at 1, 3, and 5 years after the procedure, respectively. Follow-up CT revealed that the modified percutaneous transhepatic variceal embolization procedure with 2-OCA can achieve long-lasting obliteration in the entire varices and in all the feeding veins. The cumulative survival rates at 1, 3, and 5 years after the procedure were 96.9%, 68.9%, and 53.7%. No severe complications occurred after the procedure.
  
  
  CONCLUSIONS
  The modified percutaneous transhepatic variceal embolization with 2-OCA is considered to be an effective and safe method for the extensive and permanent obliteration of both gastric varices and their feeding veins.
authors.affiliation: Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Rd, Jinan 250021, China.
authors.forename: Xiangguo
authors.initials: X
authors.lastname: Tian
authors.forename: Qizhi
authors.initials: Q
authors.lastname: Wang
authors.forename: Chunqing
authors.initials: C
authors.lastname: Zhang
authors.forename: Fuli
authors.initials: F
authors.lastname: Liu
authors.forename: Yi
authors.initials: Y
authors.lastname: Cui
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.forename: Jiyong
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011172:Portography; D016016:Proportional Hazards Models; D012008:Recurrence; D015996:Survival Rate; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate