title: Endoscopic cyanoacrylate injection with or without lauromacrogol for gastric varices: A randomized pilot study.
abstract: OBJECTIVE
  Current guidelines recommend injection of cyanoacrylate as first-line therapy to prevent gastric variceal rebleeding. The method still poses a risk of ectopic embolism, which possibly correlates with the volume of cyanoacrylate used. In this trial, we evaluated the short-term efficacy and safety of tissue adhesive injection combined with lauromacrogol for treating gastric varices.
  
  
  METHODS
  Patients admitted to our hospital for variceal hemorrhage were enrolled and blindly randomized into two treatment groups: lauromacrogol group (lauromacrogol-cyanoacrylate-lauromacrogol) and lipiodol group (lipiodol-cyanoacrylate-lipiodol). Patient follow-up was 6 months. Primary outcome was rebleeds, and secondary outcomes were mortality, gastric varices eradication, and treatment-related adverse events.
  
  
  RESULTS
  Between March 6, 2013 and October 16, 2013, 96 patients met the criteria. Two cases were lost to follow-up, and all treated cases were successful. No procedural-related adverse events were observed in either group. Cyanoacrylate volumes used in the lauromacrogol group were significantly less than those of the lipiodol group (0.9 ± 0.5 vs 2.0 ± 1.2 mL, P = 0.000). Eleven patients developed upper gastrointestinal rebleeding, which did not show significant difference between groups. On multivaritate analysis, portal venous thrombosis and fever were potential risk factors of rebleeding. Treatment failure, complications, gastric varices obturation, and survival did not differ between the two groups.
  
  
  CONCLUSIONS
  Tissue adhesives combined with lauromacrogol is a safe therapeutic option for gastric varices, with comparably less cyanoacrylate volume used. Because of the small number of study patients, it cannot be proven to have better efficacy than without lauromacrogol. Multicenter studies with larger patient groups are necessary.
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Zeng
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Tseng
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Chun-Xiao
authors.initials: CX
authors.lastname: Cui
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Tian-Cheng
authors.initials: TC
authors.lastname: Luo
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.|Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Shi-Yao
authors.initials: SY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004361:Drug Tolerance; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy*; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005334:Fever; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D005773:Gastroscopy; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011169:Portal Vein; D012008:Recurrence; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D014014:Tissue Adhesives / Q000008:administration & dosage*; D020246:Venous Thrombosis
chemical_list: D003487:Cyanoacrylates; D012597:Sclerosing Solutions; D014014:Tissue Adhesives; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004998:Ethiodized Oil
keywords: gastric varices; randomized controlled trial; sclerotherapy; tissue adhesives