title: Management of bleeding gastric varices: a single session of histoacryl injection may be sufficient.
abstract: OBJECTIVE
  Gastric variceal bleeding is one of the most feared complications of portal hypertension and hence merits investigation for its optimal therapy. We aimed to evaluate the efficacy and long-term outcome(s) of patients treated with a single session of histoacryl sclerotherapy for active gastric variceal bleeding.
  
  
  METHODS
  The medical records of patients who presented with active gastric variceal bleeding between 1998 and 2011 in a tertiary care setting were evaluated retrospectively and the eventual outcome(s) (initial hemostasis, rebleeding, and mortality rate) was assessed at least 1 year after the index bleed.
  
  
  RESULTS
  Ninety-seven patients were included. The mean age of the patients was 51.0 ± 12.5 years; 62% were men. Hepatitis C was the most common etiology, found in 63 (65%) patients. The majority of the patients were classified as Child-Pugh grade B and C: 44 (46%) and 29 (31%) patients, respectively. A total of 40 (41%) patients were IGV1, 35 (36%) patients were GOV 2, 20 (21%) patients were GOV 1, and 2 (2%) patients were IGV2. A single session of histoacryl was successful in controlling bleeding in 83 (86%) patients. Seven (7%) patients died during the hospital stay. Rebleeding was observed in 24 (27%) patients during the 1-year follow-up, of whom 12 (50%) were managed successfully with repeated histoacryl injection. The overall mortality rate at 6 weeks, 6 months, and 1 year was 14 (14%), 19 (20%) and 26 (27%) patients, respectively. Child-Pugh classification was a significant prognostic factor of survival (P<0.001).
  
  
  CONCLUSIONS
  A single session of histoacryl sclerotherapy is effective in the majority of patients with active gastric variceal bleeding. Rebleeding was observed in one-fourth of patients, half of whom were controlled successfully by repeated histoacryl sclerotherapy.
authors.affiliation: aMedical College, The Aga Khan University bDepartment of Medicine, Section of Gastroenterology, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Ali
authors.initials: A
authors.lastname: Khawaja
authors.forename: Ambreen A
authors.initials: AA
authors.lastname: Sonawalla
authors.forename: Sana F
authors.initials: SF
authors.lastname: Somani
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
mesh_terms: D000328:Adult; D004659:Enbucrilate / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D015552:Injections, Intralesional; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D004659:Enbucrilate