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Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial.
J Hepatol. 2011 Jun; 54(6):1161-7.JH

Abstract

BACKGROUND & AIMS

Gastric variceal bleeding is severe and is associated with high mortality. We compared the efficacy of cyanoacrylate injection and beta-blockers in primary prophylaxis of gastric variceal bleeding.

METHODS

Cirrhotics with large gastroesophageal varices type 2 with eradicated esophageal varices or large isolated gastric varix type 1, who had never bled from gastric varix, were randomised to cyanoacrylate injection (Group I, n=30), beta-blockers (Group II, n=29) or no treatment (Group III, n=30). Primary end-points were bleeding from gastric varix or death.

RESULTS

The actuarial probability of bleeding from gastric varices over a median follow-up of 26 months was 13% in Group I, 28% in Group II (p=0.039), and 45% in Group III (p=0.003). The actuarial probability of survival was higher in the cyanoacrylate compared to the no-treatment group (90% vs. 72%, p=0.048). The median hepatic venous pressure gradient (HVPG) was increased in Group I (14-15 mm Hg, p=0.001) and III (14-16 mm Hg, p=0.001) but decreased in Group II (14 to 12 mm Hg, p=0.001) during follow-up. Size of gastric varix >20 mm, a MELD score ≥17, and presence of portal hypertensive gastropathy predicted 'high risk' of first bleeding from gastric varices.

CONCLUSIONS

Primary prophylaxis is recommended in patients with large and high risk gastric varices to reduce the risk of first bleeding and mortality. Cyanoacrylate injection is more effective than beta-blocker therapy in preventing first gastric variceal bleeding.

Authors+Show Affiliations

Department of Gastroenterology, G B Pant Hospital, New Delhi, India.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

21145834

Citation

Mishra, Smruti Ranjan, et al. "Primary Prophylaxis of Gastric Variceal Bleeding Comparing Cyanoacrylate Injection and Beta-blockers: a Randomized Controlled Trial." Journal of Hepatology, vol. 54, no. 6, 2011, pp. 1161-7.
Mishra SR, Sharma BC, Kumar A, et al. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. J Hepatol. 2011;54(6):1161-7.
Mishra, S. R., Sharma, B. C., Kumar, A., & Sarin, S. K. (2011). Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. Journal of Hepatology, 54(6), 1161-7. https://doi.org/10.1016/j.jhep.2010.09.031
Mishra SR, et al. Primary Prophylaxis of Gastric Variceal Bleeding Comparing Cyanoacrylate Injection and Beta-blockers: a Randomized Controlled Trial. J Hepatol. 2011;54(6):1161-7. PubMed PMID: 21145834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. AU - Mishra,Smruti Ranjan, AU - Sharma,Barjesh Chander, AU - Kumar,Ashish, AU - Sarin,Shiv Kumar, Y1 - 2010/11/05/ PY - 2010/06/07/received PY - 2010/08/28/revised PY - 2010/09/07/accepted PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/9/29/medline SP - 1161 EP - 7 JF - Journal of hepatology JO - J Hepatol VL - 54 IS - 6 N2 - BACKGROUND & AIMS: Gastric variceal bleeding is severe and is associated with high mortality. We compared the efficacy of cyanoacrylate injection and beta-blockers in primary prophylaxis of gastric variceal bleeding. METHODS: Cirrhotics with large gastroesophageal varices type 2 with eradicated esophageal varices or large isolated gastric varix type 1, who had never bled from gastric varix, were randomised to cyanoacrylate injection (Group I, n=30), beta-blockers (Group II, n=29) or no treatment (Group III, n=30). Primary end-points were bleeding from gastric varix or death. RESULTS: The actuarial probability of bleeding from gastric varices over a median follow-up of 26 months was 13% in Group I, 28% in Group II (p=0.039), and 45% in Group III (p=0.003). The actuarial probability of survival was higher in the cyanoacrylate compared to the no-treatment group (90% vs. 72%, p=0.048). The median hepatic venous pressure gradient (HVPG) was increased in Group I (14-15 mm Hg, p=0.001) and III (14-16 mm Hg, p=0.001) but decreased in Group II (14 to 12 mm Hg, p=0.001) during follow-up. Size of gastric varix >20 mm, a MELD score ≥17, and presence of portal hypertensive gastropathy predicted 'high risk' of first bleeding from gastric varices. CONCLUSIONS: Primary prophylaxis is recommended in patients with large and high risk gastric varices to reduce the risk of first bleeding and mortality. Cyanoacrylate injection is more effective than beta-blocker therapy in preventing first gastric variceal bleeding. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/21145834/Primary_prophylaxis_of_gastric_variceal_bleeding_comparing_cyanoacrylate_injection_and_beta_blockers:_a_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(10)00947-5 DB - PRIME DP - Unbound Medicine ER -