title: Outcomes of endoscopic human thrombin injection in the management of gastric varices.
abstract: OBJECTIVE
  Endoscopic human thrombin injection appears to be a technically simple and efficacious alternative to tissue adhesives with fewer complications; however, data remain limited. We analysed our experience using endoscopic human thrombin injection for gastric varices in a tertiary referral liver unit.
  
  
  METHODS
  Thirty patients received thrombin injection for gastric varices between December 2008 and January 2013. Twenty patients (67%) had active bleeding or signs of recent bleeding at endoscopy. Ten patients (33%) received thrombin for prophylaxis of rebleeding: secondary (eight patients) and primary (two patients).
  
  
  RESULTS
  The mean thrombin dose/injection was 1100 IU (range 400-2500); the mean number of sessions was two (range 1-9), with no reported complications. Haemostasis was achieved in 18 out of 20 (90%) patients treated acutely. Failure to control bleeding (bleeding before day 5) was seen in seven patients: three died and four were managed successfully [two with further thrombin and two using a salvage transjugular intrahepatic portosystemic shunt (TIPSS)]. Rebleeding occurred in a further four patients, all managed successfully with salvage TIPSS. In the prophylaxis group, rebleeding occurred in two out of 10 patients.The median follow-up period was 672 days (interquartile range 92-1331). One patient underwent liver transplantation. Ten deaths occurred in total: four due to gastric variceal bleeding. Six-week survival was 83%. In cases in which TIPSS was precluded, 91% of patients (10 out of 11 patients) were managed successfully with thrombin.
  
  
  CONCLUSIONS
  Endoscopic thrombin therapy for gastric variceal bleeding may have most utility as a safe and easily applied bridge to more definitive therapy, in secondary prophylaxis of rebleeding and in cases in which TIPSS is precluded.
authors.affiliation: Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Smith
authors.forename: Robert
authors.initials: R
authors.lastname: Tidswell
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Tripathi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D005773:Gastroscopy / Q000379:methods; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013917:Thrombin / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D013917:Thrombin