Tags

Type your tag names separated by a space and hit enter

Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, and randomized study in Child-Pugh class C patients.
Endoscopy. 2001 May; 33(5):421-7.E

Abstract

BACKGROUND AND STUDY AIMS

Despite the recognized efficacy of sclerotherapy and elastic band ligation in controlling variceal hemorrhage, the results of endoscopic treatment in Child-Pugh class C patients remain poor. The aim of this prospective, controlled, and randomized study was to compare conventional sclerotherapy with injection of the tissue adhesive N-butyl-2-cyanoacrylate in controlling the first episode of rupturing of esophageal varices.

PATIENTS AND METHODS

From January 1994 to June 1997, 36 consecutive Child-Pugh class C cirrhotic patients were admitted with an initial episode of esophageal variceal bleeding. They were randomly assigned to receive sclerotherapy with a 3% ethanolamine oleate solution (group 1, 18 patients) or injection of tissue adhesive (group 2, 18 patients). Episodes of recurrent bleeding were managed after the randomization procedure. After bleeding had been controlled, patients in both groups received weekly sessions of conventional sclerotherapy to eradicate any remaining esophageal veins.

RESULTS

The patients in the two treatment groups had similar characteristics on entry into the study. More than 80% of the patients were admitted with moderate or severe hemorrhage. Approximately half of them presented with active bleeding during the index endoscopy. Early recurrent bleeding was observed in ten of the 18 patients in group 1 (55.6%) and in two of the 18 in group 2 (11.1%; P = 0.01). The hospital mortality rates were 72.2% in group I and 33.3% in group II (P = 0.04).

CONCLUSION

These findings support the view that cyanoacrylate injection is superior to conventional sclerosis for controlling esophageal variceal bleeding in Child-Pugh class C patients. It is also highly probable that the better bleeding control achieved using the cyanoacrylate tissue adhesive treatment led to a lower hospital mortality rate.

Authors+Show Affiliations

Endoscopic Unit, Medical Faculty, University of São Paulo Hospital, SP, Brazil. diasonfmf@nw.com.brNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

11396760

Citation

Maluf-Filho, F, et al. "Endoscopic Sclerosis Versus Cyanoacrylate Endoscopic Injection for the First Episode of Variceal Bleeding: a Prospective, Controlled, and Randomized Study in Child-Pugh Class C Patients." Endoscopy, vol. 33, no. 5, 2001, pp. 421-7.
Maluf-Filho F, Sakai P, Ishioka S, et al. Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, and randomized study in Child-Pugh class C patients. Endoscopy. 2001;33(5):421-7.
Maluf-Filho, F., Sakai, P., Ishioka, S., & Matuguma, S. E. (2001). Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, and randomized study in Child-Pugh class C patients. Endoscopy, 33(5), 421-7.
Maluf-Filho F, et al. Endoscopic Sclerosis Versus Cyanoacrylate Endoscopic Injection for the First Episode of Variceal Bleeding: a Prospective, Controlled, and Randomized Study in Child-Pugh Class C Patients. Endoscopy. 2001;33(5):421-7. PubMed PMID: 11396760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, and randomized study in Child-Pugh class C patients. AU - Maluf-Filho,F, AU - Sakai,P, AU - Ishioka,S, AU - Matuguma,S E, PY - 2001/6/9/pubmed PY - 2001/10/26/medline PY - 2001/6/9/entrez SP - 421 EP - 7 JF - Endoscopy JO - Endoscopy VL - 33 IS - 5 N2 - BACKGROUND AND STUDY AIMS: Despite the recognized efficacy of sclerotherapy and elastic band ligation in controlling variceal hemorrhage, the results of endoscopic treatment in Child-Pugh class C patients remain poor. The aim of this prospective, controlled, and randomized study was to compare conventional sclerotherapy with injection of the tissue adhesive N-butyl-2-cyanoacrylate in controlling the first episode of rupturing of esophageal varices. PATIENTS AND METHODS: From January 1994 to June 1997, 36 consecutive Child-Pugh class C cirrhotic patients were admitted with an initial episode of esophageal variceal bleeding. They were randomly assigned to receive sclerotherapy with a 3% ethanolamine oleate solution (group 1, 18 patients) or injection of tissue adhesive (group 2, 18 patients). Episodes of recurrent bleeding were managed after the randomization procedure. After bleeding had been controlled, patients in both groups received weekly sessions of conventional sclerotherapy to eradicate any remaining esophageal veins. RESULTS: The patients in the two treatment groups had similar characteristics on entry into the study. More than 80% of the patients were admitted with moderate or severe hemorrhage. Approximately half of them presented with active bleeding during the index endoscopy. Early recurrent bleeding was observed in ten of the 18 patients in group 1 (55.6%) and in two of the 18 in group 2 (11.1%; P = 0.01). The hospital mortality rates were 72.2% in group I and 33.3% in group II (P = 0.04). CONCLUSION: These findings support the view that cyanoacrylate injection is superior to conventional sclerosis for controlling esophageal variceal bleeding in Child-Pugh class C patients. It is also highly probable that the better bleeding control achieved using the cyanoacrylate tissue adhesive treatment led to a lower hospital mortality rate. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/11396760/Endoscopic_sclerosis_versus_cyanoacrylate_endoscopic_injection_for_the_first_episode_of_variceal_bleeding:_a_prospective_controlled_and_randomized_study_in_Child_Pugh_class_C_patients_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2001-14257 DB - PRIME DP - Unbound Medicine ER -