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Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial.
Gut. 2010 Jun; 59(6):729-35.Gut

Abstract

BACKGROUND AND AIMS

Bleeding from gastric varices is often severe and difficult to manage. Endoscopic injection of gastric varices with cyanoacrylate is effective in prevention of rebleeding. The efficacy of beta-blockers in secondary prophylaxis of gastric variceal bleed has not been well studied. A comparison of the efficacy of beta-blocker treatment and cyanoacrylate injection for the prevention of gastric variceal rebleeding was carried out.

METHODS

Patients with gastro-oesophageal varices type 2 (GOV2) with eradicated oesophageal varices or isolated gastric varices type 1 (IGV1) who had bled from gastric varices were randomised to cyanoacrylate injection (n=33) or beta-blocker treatment (n=34). Baseline and follow-up upper gastrointestinal endoscopy and hepatic venous pressure gradient (HVPG) measurements were performed. Primary end points were gastric variceal rebleeding or death.

RESULTS

The probability of gastric variceal rebleeding rate in the cyanoacrylate group was significantly lower than in the beta-blocker group (15% vs 55%, p=0.004) and the mortality rate was lower (3% vs 25%, p=0.026) during a median follow-up of 26 months. The median baseline and follow-up HVPG in the cyanoacrylate group were 15 (10-23) and 17 (11-24) mm Hg (p=0.001) and for the beta-blocker group 14 (11-24) and 13 (8-25) mm Hg (p=0.003). While no patient showed reduction of HVPG in the cyanoacrylate group, in the beta-blocker group 12 of 28 (42%) patients were responders, of which 5 (41% of responders) bled. On multivariate analysis, treatment method, portal hypertensive gastropathy and size of the gastric varix >20 mm independently correlated with gastric variceal rebleeding. Gastric variceal rebleeding independently correlated with mortality.

CONCLUSIONS

Cyanoacrylate injection is more effective than beta-blocker treatment for the prevention of gastric variceal rebleeding and improving survival.

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Authors+Show Affiliations

Mishra SR
Department of Gastroenterology, G B Pant Hospital, 201 Academic Block, New Delhi 110002, India.
Chander Sharma B
No affiliation info available
Kumar A
No affiliation info available
Sarin SK
No affiliation info available

MeSH

AdolescentAdrenergic beta-AntagonistsAdultAgedChildCyanoacrylatesEmbolization, TherapeuticEndoscopy, GastrointestinalEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHepatic VeinsHumansMaleMiddle AgedPrognosisPropranololRecurrenceRisk FactorsSurvival AnalysisTissue AdhesivesTreatment OutcomeVenous PressureYoung Adult

Pub Type(s)

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

Language

eng

PubMed ID

20551457

Clinical Trial Links

Clinical trial which this article describes

Citation

Mishra, Smruti Ranjan, et al. "Endoscopic Cyanoacrylate Injection Versus Beta-blocker for Secondary Prophylaxis of Gastric Variceal Bleed: a Randomised Controlled Trial." Gut, vol. 59, no. 6, 2010, pp. 729-35.
Mishra SR, Chander Sharma B, Kumar A, et al. Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. Gut. 2010;59(6):729-35.
Mishra, S. R., Chander Sharma, B., Kumar, A., & Sarin, S. K. (2010). Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. Gut, 59(6), 729-35. https://doi.org/10.1136/gut.2009.192039
Mishra SR, et al. Endoscopic Cyanoacrylate Injection Versus Beta-blocker for Secondary Prophylaxis of Gastric Variceal Bleed: a Randomised Controlled Trial. Gut. 2010;59(6):729-35. PubMed PMID: 20551457.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. AU - Mishra,Smruti Ranjan, AU - Chander Sharma,Barjesh, AU - Kumar,Ashish, AU - Sarin,Shiv Kumar, PY - 2010/6/17/entrez PY - 2010/6/17/pubmed PY - 2010/7/14/medline SP - 729 EP - 35 JF - Gut JO - Gut VL - 59 IS - 6 N2 - BACKGROUND AND AIMS: Bleeding from gastric varices is often severe and difficult to manage. Endoscopic injection of gastric varices with cyanoacrylate is effective in prevention of rebleeding. The efficacy of beta-blockers in secondary prophylaxis of gastric variceal bleed has not been well studied. A comparison of the efficacy of beta-blocker treatment and cyanoacrylate injection for the prevention of gastric variceal rebleeding was carried out. METHODS: Patients with gastro-oesophageal varices type 2 (GOV2) with eradicated oesophageal varices or isolated gastric varices type 1 (IGV1) who had bled from gastric varices were randomised to cyanoacrylate injection (n=33) or beta-blocker treatment (n=34). Baseline and follow-up upper gastrointestinal endoscopy and hepatic venous pressure gradient (HVPG) measurements were performed. Primary end points were gastric variceal rebleeding or death. RESULTS: The probability of gastric variceal rebleeding rate in the cyanoacrylate group was significantly lower than in the beta-blocker group (15% vs 55%, p=0.004) and the mortality rate was lower (3% vs 25%, p=0.026) during a median follow-up of 26 months. The median baseline and follow-up HVPG in the cyanoacrylate group were 15 (10-23) and 17 (11-24) mm Hg (p=0.001) and for the beta-blocker group 14 (11-24) and 13 (8-25) mm Hg (p=0.003). While no patient showed reduction of HVPG in the cyanoacrylate group, in the beta-blocker group 12 of 28 (42%) patients were responders, of which 5 (41% of responders) bled. On multivariate analysis, treatment method, portal hypertensive gastropathy and size of the gastric varix >20 mm independently correlated with gastric variceal rebleeding. Gastric variceal rebleeding independently correlated with mortality. CONCLUSIONS: Cyanoacrylate injection is more effective than beta-blocker treatment for the prevention of gastric variceal rebleeding and improving survival. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/20551457/Endoscopic_cyanoacrylate_injection_versus_beta_blocker_for_secondary_prophylaxis_of_gastric_variceal_bleed:_a_randomised_controlled_trial_ L2 - https://gut.bmj.com/lookup/pmidlookup?view=long&pmid=20551457 DB - PRIME DP - Unbound Medicine ER -