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KMID : 0338420140290040437
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The Korean Journal of Internal Medicine
2014 Volume.29 No. 4 p.437 ~ p.444
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Clinical outcomes of gastric variceal obliteration using N-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage
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Jun Chung-Hwan
Kim Ka-Rham
Yoon Jae-Hyun
Koh Han-Ra
Choi Won-Suk
Cho Kyu-Man
Lim Sung-Uk
Park Chang-Hwan
Joo Young-Eun
Kim Hyun-Soo
Choi Sung-Kyu
Rew Jong-Sun
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Abstract
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Background/Aims: To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices.
Methods: We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients’ endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding- related death rates were reviewed.
Results: Hemostasis was achieved initially in 96.9% (441/455) of patients; rebleeding occurred in 35.2% (160/455), and the bleeding-related death rate was 6.8% (31/455) during follow-up. Complications included fever (6.8%), abdominal pain (3.7%), diarrhea (1.3%), spontaneous bacterial peritonitis (0.7%), bacteremia (0.4%), and embolism (0.2%). A red-color sign on concomitant esophageal varices (EVs) (p = 0.002) and previous history of variceal bleeding (p < 0.001) were significant risk factors for rebleeding within 1 year. The Child-Pugh score (p < 0.001), presence of hepatocellular carcinoma (p = 0.001), and failure of initial hemostasis (p < 0.001) were the risk factors most closely associated with bleeding-related death.
Conclusions: This study provides a comprehensive overview of the outcomes and prognostic factors of patients with GVH. The results may help in the selection of effective treatment strategies for patients with GVH.
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KEYWORD
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Esophageal and gastric varices, Cyanoacrylates, Hemostasis, Endoscopy, Treatment outcome
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