title: Human thrombin for the treatment of gastric and ectopic varices.
abstract: OBJECTIVE
  To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices.
  
  
  METHODS
  Retrospective observational study in a Tertiary Referral Centre. Between January 1999-October 2005, we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices. Patient details including age, gender and aetiology of liver disease/segmental portal hypertension were documented. The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle. All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded. Initial haemostasis rates, rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin therapy. The duration of follow up was also listed. The study was conducted according to the United Kingdom research ethics guidelines.
  
  
  RESULTS
  Thirty-seven patients were included. 33 patients (89%) had thrombin (250 U/mL) for gastric varices, 2 (5.4%) for duodenal varices, 1 for rectal varices and 1 for gastric and rectal varices. (1) Gastric varices, an average of 15.2 mL of thrombin was used per patient. Re-bleeding occurred in 4 patients (10.8%), managed in 2 by a transjugular intrahepatic portosystemic shunt (TIPSS) (one unsuccessfully who died) and in other 2 by a distal splenorenal shunt; (2) Duodenal varices (or type 2 isolated gastric varices), an average of 12.5 mL was used per patient over 2-3 endoscopy sessions. Re-bleeding occurred in one patient, which was treated by TIPSS; and (3) Rectal varices, an average of 18.3 mL was used per patient over 3 endoscopy sessions. No re-bleeding occurred in this group.
  
  
  CONCLUSIONS
  Human thrombin is a safe, easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.
authors.affiliation: Department of Hepatology, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom. norma.mcavoy@ed.ac.uk
authors.forename: Norma C
authors.initials: NC
authors.lastname: McAvoy
authors.forename: John N
authors.initials: JN
authors.lastname: Plevris
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013917:Thrombin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006490:Hemostatics; D013917:Thrombin
keywords: Ectopic Varices; Gastric varices; Portal hypertension; Thrombin; Variceal haemorrhage