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A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation.
Hepatology. 2006 Apr; 43(4):690-7.Hep

Abstract

Progression of gastric variceal hemorrhage (GVH) is poorer than esophageal variceal bleeding. However, data on its optimal treatment are limited. We designed a prospective study to compare the efficacy of endoscopic band ligation (GVL) and endoscopic N-butyl-2-cyanoacrylate injection (GVO). Liver patients with cirrhosis with or without concomitant hepatocellular carcinoma (HCC) and patients presenting with acute GVH were randomized into two treatment groups. Forty-eight patients received GVL, and another 49 patients received GVO. Both treatments were equally successful in controlling active bleeding (14/15 vs. 14/15, P = 1.000). More of the patients who underwent GVL had GV rebleeding (GVL vs. GVO, 21/48 vs. 11/49; P = .044). The 2-year and 3-year cumulative rate of GV rebleeding were 63.1% and 72.3% for GVL, and 26.8% for both periods with GVO; P = .0143, log-rank test. The rebleeding risk of GVL was sustained throughout the entire follow-up period. Multivariate Cox regression indicated that concomitance with HCC (relative hazard: 2.453, 95% CI: 1.036-5.806, P = .041) and the treatment method (GVL vs. GVO, relative hazard: 2.660, 95% CI: 1.167-6.061, P = .020) were independent factors predictive of GV rebleeding. There was no difference in survival between the two groups. Severe complications attributable to these two treatments were rare. In conclusion, the efficacy of GVL to control active GVH appears not different to GVO, but GVO is associated with a lower GV rebleeding rate.

Authors+Show Affiliations

Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16557539

Citation

Tan, Pen-Chung, et al. "A Randomized Trial of Endoscopic Treatment of Acute Gastric Variceal Hemorrhage: N-butyl-2-cyanoacrylate Injection Versus Band Ligation." Hepatology (Baltimore, Md.), vol. 43, no. 4, 2006, pp. 690-7.
Tan PC, Hou MC, Lin HC, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006;43(4):690-7.
Tan, P. C., Hou, M. C., Lin, H. C., Liu, T. T., Lee, F. Y., Chang, F. Y., & Lee, S. D. (2006). A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology (Baltimore, Md.), 43(4), 690-7.
Tan PC, et al. A Randomized Trial of Endoscopic Treatment of Acute Gastric Variceal Hemorrhage: N-butyl-2-cyanoacrylate Injection Versus Band Ligation. Hepatology. 2006;43(4):690-7. PubMed PMID: 16557539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. AU - Tan,Pen-Chung, AU - Hou,Ming-Chih, AU - Lin,Han-Chieh, AU - Liu,Tsu-Te, AU - Lee,Fa-Yauh, AU - Chang,Full-Young, AU - Lee,Shou-Dong, PY - 2006/3/25/pubmed PY - 2006/5/5/medline PY - 2006/3/25/entrez SP - 690 EP - 7 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 43 IS - 4 N2 - Progression of gastric variceal hemorrhage (GVH) is poorer than esophageal variceal bleeding. However, data on its optimal treatment are limited. We designed a prospective study to compare the efficacy of endoscopic band ligation (GVL) and endoscopic N-butyl-2-cyanoacrylate injection (GVO). Liver patients with cirrhosis with or without concomitant hepatocellular carcinoma (HCC) and patients presenting with acute GVH were randomized into two treatment groups. Forty-eight patients received GVL, and another 49 patients received GVO. Both treatments were equally successful in controlling active bleeding (14/15 vs. 14/15, P = 1.000). More of the patients who underwent GVL had GV rebleeding (GVL vs. GVO, 21/48 vs. 11/49; P = .044). The 2-year and 3-year cumulative rate of GV rebleeding were 63.1% and 72.3% for GVL, and 26.8% for both periods with GVO; P = .0143, log-rank test. The rebleeding risk of GVL was sustained throughout the entire follow-up period. Multivariate Cox regression indicated that concomitance with HCC (relative hazard: 2.453, 95% CI: 1.036-5.806, P = .041) and the treatment method (GVL vs. GVO, relative hazard: 2.660, 95% CI: 1.167-6.061, P = .020) were independent factors predictive of GV rebleeding. There was no difference in survival between the two groups. Severe complications attributable to these two treatments were rare. In conclusion, the efficacy of GVL to control active GVH appears not different to GVO, but GVO is associated with a lower GV rebleeding rate. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/16557539/A_randomized_trial_of_endoscopic_treatment_of_acute_gastric_variceal_hemorrhage:_N_butyl_2_cyanoacrylate_injection_versus_band_ligation_ DB - PRIME DP - Unbound Medicine ER -