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Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis.
Gastrointest Endosc. 2009 Nov; 70(5):881-7.GE

Abstract

BACKGROUND AND OBJECTIVES

Gastric variceal hemorrhage treatment remains a difficult issue for clinicians. There is controversy regarding whether first-line treatment should be endoscopic therapy with cyanoacrylate glue or placement of a transjugular intrahepatic portosystemic shunt (TIPS). We compared these methods on the basis of rebleeding, survival, and complications. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: This was a retrospective cohort analysis of cirrhotic patients with gastric variceal hemorrhage treated with endoscopic cyanoacrylate therapy or TIPS placement at a single U.S. center from 1997 to 2007. The groups were compared for rebleeding at 72 hours, 3 months, and 1 year; survival rates at 3 months and 1 year; and acute and extended complications and morbidity.

MAIN OUTCOME MEASUREMENTS AND RESULTS

A total of 105 patients were included. There were no significant pretreatment differences between the 2 groups in age, sex, MELD (Model for End-Stage Liver Disease) score at the time of admission, or cause of liver disease. There were no significant differences in rebleeding at 72 hours, 3 months, and 1 year; survival at 3 months and 1 year; and aggregate long-term survival or acute complications. However, the TIPS group had a higher rate of long-term morbidity requiring hospitalization (41% with a TIPS and 1.6% in the cyanoacrylate arm, P < .0001).

LIMITATIONS

Retrospective and uncontrolled samples.

CONCLUSION

In patients with similar characteristics, cyanoacrylate therapy performed as well as a TIPS in controlling and preventing gastric variceal hemorrhage with no significant differences in survival. Patients receiving cyanoacrylate therapy experienced significantly less long-term morbidity related to therapy than patients who received a TIPS. Cyanoacrylate therapy appears to be safe and effective and compares favorably with TIPS therapy.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA 22908-0708, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19559425

Citation

Procaccini, Nicholas J., et al. "Endoscopic Cyanoacrylate Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Variceal Bleeding: a Single-center U.S. Analysis." Gastrointestinal Endoscopy, vol. 70, no. 5, 2009, pp. 881-7.
Procaccini NJ, Al-Osaimi AM, Northup P, et al. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc. 2009;70(5):881-7.
Procaccini, N. J., Al-Osaimi, A. M., Northup, P., Argo, C., & Caldwell, S. H. (2009). Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointestinal Endoscopy, 70(5), 881-7. https://doi.org/10.1016/j.gie.2009.03.1169
Procaccini NJ, et al. Endoscopic Cyanoacrylate Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Variceal Bleeding: a Single-center U.S. Analysis. Gastrointest Endosc. 2009;70(5):881-7. PubMed PMID: 19559425.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. AU - Procaccini,Nicholas J, AU - Al-Osaimi,Abdullah M S, AU - Northup,Patrick, AU - Argo,Curtis, AU - Caldwell,Stephen H, Y1 - 2009/06/25/ PY - 2008/09/30/received PY - 2009/03/20/accepted PY - 2009/6/30/entrez PY - 2009/6/30/pubmed PY - 2010/1/20/medline SP - 881 EP - 7 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 70 IS - 5 N2 - BACKGROUND AND OBJECTIVES: Gastric variceal hemorrhage treatment remains a difficult issue for clinicians. There is controversy regarding whether first-line treatment should be endoscopic therapy with cyanoacrylate glue or placement of a transjugular intrahepatic portosystemic shunt (TIPS). We compared these methods on the basis of rebleeding, survival, and complications. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: This was a retrospective cohort analysis of cirrhotic patients with gastric variceal hemorrhage treated with endoscopic cyanoacrylate therapy or TIPS placement at a single U.S. center from 1997 to 2007. The groups were compared for rebleeding at 72 hours, 3 months, and 1 year; survival rates at 3 months and 1 year; and acute and extended complications and morbidity. MAIN OUTCOME MEASUREMENTS AND RESULTS: A total of 105 patients were included. There were no significant pretreatment differences between the 2 groups in age, sex, MELD (Model for End-Stage Liver Disease) score at the time of admission, or cause of liver disease. There were no significant differences in rebleeding at 72 hours, 3 months, and 1 year; survival at 3 months and 1 year; and aggregate long-term survival or acute complications. However, the TIPS group had a higher rate of long-term morbidity requiring hospitalization (41% with a TIPS and 1.6% in the cyanoacrylate arm, P < .0001). LIMITATIONS: Retrospective and uncontrolled samples. CONCLUSION: In patients with similar characteristics, cyanoacrylate therapy performed as well as a TIPS in controlling and preventing gastric variceal hemorrhage with no significant differences in survival. Patients receiving cyanoacrylate therapy experienced significantly less long-term morbidity related to therapy than patients who received a TIPS. Cyanoacrylate therapy appears to be safe and effective and compares favorably with TIPS therapy. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/19559425/Endoscopic_cyanoacrylate_versus_transjugular_intrahepatic_portosystemic_shunt_for_gastric_variceal_bleeding:_a_single_center_U_S__analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(09)01702-7 DB - PRIME DP - Unbound Medicine ER -