title: Band ligation vs. N-Butyl-2-cyanoacrylate injection in acute gastric variceal bleeding: a prospective follow-up study.
abstract: BACKGROUND. Treatment of gastric varices (GV) implies a number of several difficulties and sometimes entails complications. The best endoscopic success rate was attributed until now to the use of tissue adhesives(N-Butyl-2-Cyanoacrylate) and band ligation. AIM. To assess the therapeutic efficacy and safety of cyanoacrylate injection compared to band ligation in patients with acute GV hemorrhage. MATERIAL AND METHODS. Thirty-seven patients with upper gastrointestinal bleeding from GV were included in the study, treated with cyanoacrylate injection (GVO)-19 patients or band ligations (GVL)-18 patients. They were followed up for overall results, complications and survival rate. RESULTS. The mean age of the study group was 60.22 ± 9.34 years, with a male/female ratio of 21:16. The mean follow-up period was 427.26 ± 214.16 days in the GVO group and 406.21 ± 213.23 days in the GVL group (p = 0.76). Initial hemostasis was achieved in all patients treated with cyanoacrylate and in 88.88% from the GVL group (p = 0.43). Rebleeding occurred in 72.22% of the GVL group and in 31.57% of the GVO patients (p = 0.03). Patients in the GVO group had a significantly larger rebleeding-free period(p = 0.006). No difference was found in survival rates(p = 0.75). The Child Class (p = 0.003 for Class C) and treatment method (p = 0.01) were independently associated with the rate of rebleeding. No differences were found regarding the rate of complications. CONCLUSION. The use of cyanoacrylate in acute GV bleeding had better results when compared with band ligation in terms of controlling the hemorrhage and recurrence of bleeding. The overall survival rate was not influenced by the method used for the treatment of complicated GV.
authors.affiliation: Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor"; 3rd. Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tantau
authors.affiliation: Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor"; 3rd. Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Dana
authors.initials: D
authors.lastname: Crisan
authors.affiliation: Polisano Medical Center Sibiu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Popa
authors.affiliation: Department of Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Stefan
authors.initials: S
authors.lastname: Vesa
authors.affiliation: 4th. Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Tantau
mesh_terms: D000208:Acute Disease; D000368:Aged; D018572:Disease-Free Survival; D004659:Enbucrilate / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007267:Injections; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate