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The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome.
J Clin Gastroenterol. 2008 Sep; 42(8):916-22.JC

Abstract

BACKGROUND

Cyanoacrylate has been recommended for the treatment of gastric variceal bleeding.

GOAL

We aimed to evaluate the efficacy and safety of cyanoacrylate injection therapy in patients with gastric variceal bleeding, and to identify the factors predictive of failure, rebleeding, and survival after therapy.

STUDY

One hundred twenty-one patients with gastric variceal bleeding who received cyanoacrylate injections were retrospectively reviewed.

RESULTS

Treatment succeeded in 110 patients (90.9%). Rebleeding and mortality rate during 4-week were 13.2% and 11.6%. A stepwise logistic regression analysis indicated that only the Child-Pugh class was an independent predictive factor of treatment failure [Child-Pugh C vs. Child-Pugh A and B, odds ratio (OR), 5.0; 95% confidence interval (CI), 1.2-19.4; P=0.025]. The actuarial probability of a 4-week absence of rebleeding and survival after the initial therapy was 86.8% and 85.1%, respectively. A stepwise logistic regression analysis showed that a Child-Pugh class C and hepatocellular carcinoma were independent predictive factors for rebleeding (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively) and mortality (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively). Only 2 cases (2.7%) with serious complications, noted as cyanoacrylate embolisms, were observed. At 1-year follow up, the actuarial probability of remaining free of bleeding was 49.0% and hepatitis B virus infection was independent predictive factor of bleeding (OR, 5.3; 95% CI, 1.4-20.0; P=0.015).

CONCLUSIONS

In short-term follow-up, cyanoacrylate injection is an effective treatment method for gastric variceal bleeding and the Child-Pugh class was only independent predictive factor of treatment failure and the Child-Pugh class and the hepatocellular carcinoma were risk factors for rebleeding and survival. In long-term follow-up, the presence of hepatitis B infection was risk factor for rebleeding.

Authors+Show Affiliations

Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18645533

Citation

Paik, Chang Nyol, et al. "The Therapeutic Effect of Cyanoacrylate On Gastric Variceal Bleeding and Factors Related to Clinical Outcome." Journal of Clinical Gastroenterology, vol. 42, no. 8, 2008, pp. 916-22.
Paik CN, Kim SW, Lee IS, et al. The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome. J Clin Gastroenterol. 2008;42(8):916-22.
Paik, C. N., Kim, S. W., Lee, I. S., Park, J. M., Cho, Y. K., Choi, M. G., & Chung, I. S. (2008). The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome. Journal of Clinical Gastroenterology, 42(8), 916-22. https://doi.org/10.1097/MCG.0b013e31811edcd1
Paik CN, et al. The Therapeutic Effect of Cyanoacrylate On Gastric Variceal Bleeding and Factors Related to Clinical Outcome. J Clin Gastroenterol. 2008;42(8):916-22. PubMed PMID: 18645533.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome. AU - Paik,Chang Nyol, AU - Kim,Sang Woo, AU - Lee,In Seok, AU - Park,Jae Myung, AU - Cho,Yu Kyung, AU - Choi,Myung Gyu, AU - Chung,In Sik, PY - 2008/7/23/pubmed PY - 2008/10/29/medline PY - 2008/7/23/entrez SP - 916 EP - 22 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 42 IS - 8 N2 - BACKGROUND: Cyanoacrylate has been recommended for the treatment of gastric variceal bleeding. GOAL: We aimed to evaluate the efficacy and safety of cyanoacrylate injection therapy in patients with gastric variceal bleeding, and to identify the factors predictive of failure, rebleeding, and survival after therapy. STUDY: One hundred twenty-one patients with gastric variceal bleeding who received cyanoacrylate injections were retrospectively reviewed. RESULTS: Treatment succeeded in 110 patients (90.9%). Rebleeding and mortality rate during 4-week were 13.2% and 11.6%. A stepwise logistic regression analysis indicated that only the Child-Pugh class was an independent predictive factor of treatment failure [Child-Pugh C vs. Child-Pugh A and B, odds ratio (OR), 5.0; 95% confidence interval (CI), 1.2-19.4; P=0.025]. The actuarial probability of a 4-week absence of rebleeding and survival after the initial therapy was 86.8% and 85.1%, respectively. A stepwise logistic regression analysis showed that a Child-Pugh class C and hepatocellular carcinoma were independent predictive factors for rebleeding (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively) and mortality (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively). Only 2 cases (2.7%) with serious complications, noted as cyanoacrylate embolisms, were observed. At 1-year follow up, the actuarial probability of remaining free of bleeding was 49.0% and hepatitis B virus infection was independent predictive factor of bleeding (OR, 5.3; 95% CI, 1.4-20.0; P=0.015). CONCLUSIONS: In short-term follow-up, cyanoacrylate injection is an effective treatment method for gastric variceal bleeding and the Child-Pugh class was only independent predictive factor of treatment failure and the Child-Pugh class and the hepatocellular carcinoma were risk factors for rebleeding and survival. In long-term follow-up, the presence of hepatitis B infection was risk factor for rebleeding. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/18645533/The_therapeutic_effect_of_cyanoacrylate_on_gastric_variceal_bleeding_and_factors_related_to_clinical_outcome_ DB - PRIME DP - Unbound Medicine ER -