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The safety and probable therapeutic effect of routine use of antibiotics and simultaneously treating bleeding gastric varices by using endoscopic cyanoacrylate injection and concomitant esophageal varices with banding ligation: a pilot study.
Gastrointest Endosc. 2010 Jun; 71(7):1141-9.GE

Abstract

BACKGROUND

Gastroesophageal varices are the most common type of gastric varices. Although endoscopic injection of N-butyl-2-cyanoacrylate is the current treatment of choice for acute gastric variceal bleeding, whether the concomitant esophageal varices should be ligated simultaneously with the first treatment session is currently not known.

OBJECTIVE

The aim of this study was to evaluate the safety and probable therapeutic effect of simultaneous cyanoacrylate injection for bleeding gastric varices obliteration (GVO) and endoscopic band ligation (EBL) for concomitant esophageal varices in combination with routine antibiotics (simultaneous group), and to compare our results with historical results in which the patients underwent GVO first and then EBL for concomitant esophageal varices (separate group).

DESIGN

A single-center pilot study.

SETTING

A tertiary referral center.

PATIENTS

Patients with liver cirrhosis and gastroesophageal varices, who presented with acute gastric varices bleeding.

INTERVENTIONS

Simultaneous treatment in the form of GVO and EBL for concomitant esophageal varices in combination with routine antibiotics.

MAIN OUTCOME MEASUREMENT

Rebleeding and mortality within the first year of index bleeding.

RESULTS

Twenty patients in the simultaneous group and 67 patients in the separate group were included in the study. The 2 groups had similar baseline characteristics. The hemostasis of active bleeding was 100% in both groups (7/7 vs 20/20). The 1-year rebleeding rate was 10% (2/20) in the simultaneous group and 37.31% (25/67) in the separate group (P = .041). Kaplan-Meier analysis showed higher probability of remaining free of rebleeding in the simultaneous group (88.5% vs 61.1%; P = .044). Multivariate analysis indicated that treatment method (separate group) and high model for end-stage liver disease score (> or = 13) were independent risk factors of rebleeding in 1 year. The treatment failure, complications, 1-year mortality, and survival were similar in both groups.

CONCLUSION

Simultaneous endoscopic treatment for gastric varices bleeding and concomitant esophageal varices is a safe and effective procedure in combination with antibiotic prophylaxis for patients with cirrhosis. The 1-year mortality rate was similar between the 2 groups. The results need further validation.

Authors+Show Affiliations

Current affiliations: National Yang-Ming University School of Medicine and Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 11217.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20362285

Citation

Chang, Chen-Jung, et al. "The Safety and Probable Therapeutic Effect of Routine Use of Antibiotics and Simultaneously Treating Bleeding Gastric Varices By Using Endoscopic Cyanoacrylate Injection and Concomitant Esophageal Varices With Banding Ligation: a Pilot Study." Gastrointestinal Endoscopy, vol. 71, no. 7, 2010, pp. 1141-9.
Chang CJ, Hou MC, Lin HC, et al. The safety and probable therapeutic effect of routine use of antibiotics and simultaneously treating bleeding gastric varices by using endoscopic cyanoacrylate injection and concomitant esophageal varices with banding ligation: a pilot study. Gastrointest Endosc. 2010;71(7):1141-9.
Chang, C. J., Hou, M. C., Lin, H. C., Lee, H. S., Liao, W. C., Su, C. W., & Lee, S. D. (2010). The safety and probable therapeutic effect of routine use of antibiotics and simultaneously treating bleeding gastric varices by using endoscopic cyanoacrylate injection and concomitant esophageal varices with banding ligation: a pilot study. Gastrointestinal Endoscopy, 71(7), 1141-9. https://doi.org/10.1016/j.gie.2009.12.010
Chang CJ, et al. The Safety and Probable Therapeutic Effect of Routine Use of Antibiotics and Simultaneously Treating Bleeding Gastric Varices By Using Endoscopic Cyanoacrylate Injection and Concomitant Esophageal Varices With Banding Ligation: a Pilot Study. Gastrointest Endosc. 2010;71(7):1141-9. PubMed PMID: 20362285.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The safety and probable therapeutic effect of routine use of antibiotics and simultaneously treating bleeding gastric varices by using endoscopic cyanoacrylate injection and concomitant esophageal varices with banding ligation: a pilot study. AU - Chang,Chen-Jung, AU - Hou,Ming-Chih, AU - Lin,Han-Chieh, AU - Lee,Hai-Shin, AU - Liao,Wei-Chih, AU - Su,Chien-Wei, AU - Lee,Shou-Dong, Y1 - 2010/04/01/ PY - 2009/08/13/received PY - 2009/12/03/accepted PY - 2010/4/6/entrez PY - 2010/4/7/pubmed PY - 2010/10/13/medline SP - 1141 EP - 9 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 71 IS - 7 N2 - BACKGROUND: Gastroesophageal varices are the most common type of gastric varices. Although endoscopic injection of N-butyl-2-cyanoacrylate is the current treatment of choice for acute gastric variceal bleeding, whether the concomitant esophageal varices should be ligated simultaneously with the first treatment session is currently not known. OBJECTIVE: The aim of this study was to evaluate the safety and probable therapeutic effect of simultaneous cyanoacrylate injection for bleeding gastric varices obliteration (GVO) and endoscopic band ligation (EBL) for concomitant esophageal varices in combination with routine antibiotics (simultaneous group), and to compare our results with historical results in which the patients underwent GVO first and then EBL for concomitant esophageal varices (separate group). DESIGN: A single-center pilot study. SETTING: A tertiary referral center. PATIENTS: Patients with liver cirrhosis and gastroesophageal varices, who presented with acute gastric varices bleeding. INTERVENTIONS: Simultaneous treatment in the form of GVO and EBL for concomitant esophageal varices in combination with routine antibiotics. MAIN OUTCOME MEASUREMENT: Rebleeding and mortality within the first year of index bleeding. RESULTS: Twenty patients in the simultaneous group and 67 patients in the separate group were included in the study. The 2 groups had similar baseline characteristics. The hemostasis of active bleeding was 100% in both groups (7/7 vs 20/20). The 1-year rebleeding rate was 10% (2/20) in the simultaneous group and 37.31% (25/67) in the separate group (P = .041). Kaplan-Meier analysis showed higher probability of remaining free of rebleeding in the simultaneous group (88.5% vs 61.1%; P = .044). Multivariate analysis indicated that treatment method (separate group) and high model for end-stage liver disease score (> or = 13) were independent risk factors of rebleeding in 1 year. The treatment failure, complications, 1-year mortality, and survival were similar in both groups. CONCLUSION: Simultaneous endoscopic treatment for gastric varices bleeding and concomitant esophageal varices is a safe and effective procedure in combination with antibiotic prophylaxis for patients with cirrhosis. The 1-year mortality rate was similar between the 2 groups. The results need further validation. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/20362285/The_safety_and_probable_therapeutic_effect_of_routine_use_of_antibiotics_and_simultaneously_treating_bleeding_gastric_varices_by_using_endoscopic_cyanoacrylate_injection_and_concomitant_esophageal_varices_with_banding_ligation:_a_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(09)02864-8 DB - PRIME DP - Unbound Medicine ER -