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A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL.
Gastrointest Endosc. 2009 Oct; 70(4):668-75.GE

Abstract

BACKGROUND

Endoscopic injection of N-butyl-2-cyanoacrylate is the preferred method to treat acute gastric variceal bleeding (GVB). However, its rebleeding rate remains high.

OBJECTIVE

To compare an injection containing 0.5 mL of cyanoacrylate (group A) with an injection containing 1.0 mL of cyanoacrylate (group B).

DESIGN

A single-center, randomized, controlled trial.

SETTING

A tertiary referral center.

MAIN OUTCOME MEASUREMENT

Occurrence of rebleeding.

PATIENTS

Patients with acute gastric variceal bleeding.

RESULTS

Forty-four patients in group A and 47 patients in group B were studied; their clinical characteristics were similar. The treatment stopped active bleeding in approximately 90% of cases in both groups. The rebleeding rate was 29.8% (14/47) in group B compared with 38.6% (17/44) in group A (P = .504; 95% CI, -10.592 to 28.280). On multivariate analysis, concomitant hepatocellular carcinoma, infection, and the size of the gastric varices were independent determinants of rebleeding. More patients in group B than in group A had postinjection fever (>37.5 degrees C) (23/47 vs 12/44, P = .059). Treatment failure, complications, 30-day mortality, and survival did not differ between the 2 groups.

CONCLUSIONS

Due to the small number of study patients, a double dose of cyanoacrylate injection for GVB cannot be proven to have better hemostatic efficacy than a single dose. Multicenter studies with larger patient numbers are necessary to determine whether a double dose is in fact more efficacious.

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Authors+Show Affiliations

Hou MC
Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Taipei, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan 11217.
Lin HC
No affiliation info available
Lee HS
No affiliation info available
Liao WC
No affiliation info available
Lee FY
No affiliation info available
Lee SD
No affiliation info available

MeSH

Acute DiseaseAgedDose-Response Relationship, DrugEnbucrilateEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageGastroscopyHumansInjections, IntralesionalMaleMiddle AgedTissue AdhesivesVasoconstrictor Agents

Pub Type(s)

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

Language

eng

PubMed ID

19559427

Clinical Trial Links

Clinical trial which this article describes

Citation

Hou, Ming-Chih, et al. "A Randomized Trial of Endoscopic Cyanoacrylate Injection for Acute Gastric Variceal Bleeding: 0.5 mL Versus 1.0 ML." Gastrointestinal Endoscopy, vol. 70, no. 4, 2009, pp. 668-75.
Hou MC, Lin HC, Lee HS, et al. A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL. Gastrointest Endosc. 2009;70(4):668-75.
Hou, M. C., Lin, H. C., Lee, H. S., Liao, W. C., Lee, F. Y., & Lee, S. D. (2009). A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL. Gastrointestinal Endoscopy, 70(4), 668-75. https://doi.org/10.1016/j.gie.2009.02.005
Hou MC, et al. A Randomized Trial of Endoscopic Cyanoacrylate Injection for Acute Gastric Variceal Bleeding: 0.5 mL Versus 1.0 ML. Gastrointest Endosc. 2009;70(4):668-75. PubMed PMID: 19559427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL. AU - Hou,Ming-Chih, AU - Lin,Han-Chieh, AU - Lee,Hai-Shin, AU - Liao,Wei-Chih, AU - Lee,Fa-Yauh, AU - Lee,Shou-Dong, Y1 - 2009/06/25/ PY - 2008/11/05/received PY - 2009/02/01/accepted PY - 2009/6/30/entrez PY - 2009/6/30/pubmed PY - 2009/12/22/medline SP - 668 EP - 75 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 70 IS - 4 N2 - BACKGROUND: Endoscopic injection of N-butyl-2-cyanoacrylate is the preferred method to treat acute gastric variceal bleeding (GVB). However, its rebleeding rate remains high. OBJECTIVE: To compare an injection containing 0.5 mL of cyanoacrylate (group A) with an injection containing 1.0 mL of cyanoacrylate (group B). DESIGN: A single-center, randomized, controlled trial. SETTING: A tertiary referral center. MAIN OUTCOME MEASUREMENT: Occurrence of rebleeding. PATIENTS: Patients with acute gastric variceal bleeding. RESULTS: Forty-four patients in group A and 47 patients in group B were studied; their clinical characteristics were similar. The treatment stopped active bleeding in approximately 90% of cases in both groups. The rebleeding rate was 29.8% (14/47) in group B compared with 38.6% (17/44) in group A (P = .504; 95% CI, -10.592 to 28.280). On multivariate analysis, concomitant hepatocellular carcinoma, infection, and the size of the gastric varices were independent determinants of rebleeding. More patients in group B than in group A had postinjection fever (>37.5 degrees C) (23/47 vs 12/44, P = .059). Treatment failure, complications, 30-day mortality, and survival did not differ between the 2 groups. CONCLUSIONS: Due to the small number of study patients, a double dose of cyanoacrylate injection for GVB cannot be proven to have better hemostatic efficacy than a single dose. Multicenter studies with larger patient numbers are necessary to determine whether a double dose is in fact more efficacious. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/19559427/A_randomized_trial_of_endoscopic_cyanoacrylate_injection_for_acute_gastric_variceal_bleeding:_0_5_mL_versus_1_0_mL_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(09)00255-7 DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓15 ↑1]

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