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EUS-guided injection of cyanoacrylate for bleeding gastric varices.
Gastrointest Endosc. 2000 Aug; 52(2):168-74.GE

Abstract

BACKGROUND

Bleeding gastric varices is a highly fatal condition. Recurrent bleeding after hemostasis achieved by endoscopic methods is common, and obliteration of gastric varices is difficult to assess. Our aim was to investigate the use of endosonography (EUS) in monitoring cyanoacrylate injection to obliterate gastric varices.

METHODS

Patients who presented with bleeding gastric varices were treated with bolus injection(s) of cyanoacrylate (0.5 mL cyanoacrylate mixed with 0.7 mL Lipiodol) until bleeding was controlled; 47 patients received "on-demand" injection only in response to recurrent bleeding (on-demand group). Another group of 54 patients underwent biweekly EUS followed by repeated injection of cyanoacrylate (repeated-injection group) until all gastric varices were obliterated. The primary outcome was recurrent bleeding-free interval and survival rate.

RESULTS

The two groups of patients were comparable demographically. Although the rates of early (</=48 hour) bleeding recurrence were similar with repeated or on-demand injection (7.4% versus 12.8%, p = 0.5), late recurrence of bleeding (>48 hour) was significantly reduced in the repeated-injection group (18.5% versus 44.7%, p = 0.0053, odds ratio 0.28 (95% CI [0.12, 0. 69]). Cumulative probability of recurrent bleeding-free interval was higher in the repeated-injection than the on-demand group (log-rank test, p = 0.0053). There was a numeric trend toward improved survival in the repeated-injection group.

CONCLUSION

Gastric varices obliteration with cyanoacrylate under EUS monitoring reduces recurrent bleeding and may improve survival.

Authors+Show Affiliations

Departments of Medicine & Therapeutics and Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, China. leeytong@cuhk.edu.hkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

10922086

Citation

Lee, Y T., et al. "EUS-guided Injection of Cyanoacrylate for Bleeding Gastric Varices." Gastrointestinal Endoscopy, vol. 52, no. 2, 2000, pp. 168-74.
Lee YT, Chan FK, Ng EK, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52(2):168-74.
Lee, Y. T., Chan, F. K., Ng, E. K., Leung, V. K., Law, K. B., Yung, M. Y., Chung, S. C., & Sung, J. J. (2000). EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointestinal Endoscopy, 52(2), 168-74.
Lee YT, et al. EUS-guided Injection of Cyanoacrylate for Bleeding Gastric Varices. Gastrointest Endosc. 2000;52(2):168-74. PubMed PMID: 10922086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EUS-guided injection of cyanoacrylate for bleeding gastric varices. AU - Lee,Y T, AU - Chan,F K, AU - Ng,E K, AU - Leung,V K, AU - Law,K B, AU - Yung,M Y, AU - Chung,S C, AU - Sung,J J, PY - 2000/8/2/pubmed PY - 2000/9/30/medline PY - 2000/8/2/entrez SP - 168 EP - 74 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 52 IS - 2 N2 - BACKGROUND: Bleeding gastric varices is a highly fatal condition. Recurrent bleeding after hemostasis achieved by endoscopic methods is common, and obliteration of gastric varices is difficult to assess. Our aim was to investigate the use of endosonography (EUS) in monitoring cyanoacrylate injection to obliterate gastric varices. METHODS: Patients who presented with bleeding gastric varices were treated with bolus injection(s) of cyanoacrylate (0.5 mL cyanoacrylate mixed with 0.7 mL Lipiodol) until bleeding was controlled; 47 patients received "on-demand" injection only in response to recurrent bleeding (on-demand group). Another group of 54 patients underwent biweekly EUS followed by repeated injection of cyanoacrylate (repeated-injection group) until all gastric varices were obliterated. The primary outcome was recurrent bleeding-free interval and survival rate. RESULTS: The two groups of patients were comparable demographically. Although the rates of early (</=48 hour) bleeding recurrence were similar with repeated or on-demand injection (7.4% versus 12.8%, p = 0.5), late recurrence of bleeding (>48 hour) was significantly reduced in the repeated-injection group (18.5% versus 44.7%, p = 0.0053, odds ratio 0.28 (95% CI [0.12, 0. 69]). Cumulative probability of recurrent bleeding-free interval was higher in the repeated-injection than the on-demand group (log-rank test, p = 0.0053). There was a numeric trend toward improved survival in the repeated-injection group. CONCLUSION: Gastric varices obliteration with cyanoacrylate under EUS monitoring reduces recurrent bleeding and may improve survival. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/10922086/EUS_guided_injection_of_cyanoacrylate_for_bleeding_gastric_varices_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(00)21355-2 DB - PRIME DP - Unbound Medicine ER -