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Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed.
Indian J Gastroenterol. 2018 03; 37(2):153-159.IJ

Abstract

BACKGROUND AND AIMS

N-butyl-cyanoacrylate injection is recommended in bleeding/recently bled gastric varices. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. The aim of this study was to compare EUS-guided coil application combined with or without cyanoacrylate glue injection to injection alone in post-glue gastric variceal re-bleed.

METHODS

A retrospective analysis of a prospectively maintained database was performed. Thirty patients who re-bled after cyanoacrylate injection and who had EUS-guided coil application to gastric varices were included. The comparison was done with data of 51 patients who had only repeat cyanoacrylate injection. Both groups had a follow up for 12 months. EUS-guided coil application was done under endosonographic guidance. A single coil was placed in 7, two coils in each of 13 patients, three in 5, four in 3, five in one, and 6 coils in one patient. In addition, cyanoacrylate glue injection was given in 15 patients. Eight patients had repeat EUS-guided coil application 1 month later. Re-bleed and mortality were assessed.

RESULTS

Coilng: Six out of 30 (20%) patients re-bled during follow up of 9 to 365 days. Three out of 30 (10%) died. One patient died 9 days after the procedure due to acute respiratory distress syndrome, one died 4 months after the procedure due to a re-bleed and one 5 months after the procedure due to spontaneous bacterial peritonitis. Glue only: 26/51 (51%) re-bled during follow up of 45 to 365 days. EUS-guided coil application resulted in significantly less re-bleed than glue-only (Kaplan-Meir survival analysis with log-rank test, z = 5.4, p < 0.001). Two out of 51 (4%) died 59 and 186 days after the procedure.

CONCLUSION

EUS-guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.

Authors+Show Affiliations

Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India. koshyabe@yahoo.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29629510

Citation

Mukkada, Roy J., et al. "Endoscopic Ultrasound-guided Coil or Glue Injection in Post-cyanoacrylate Gastric Variceal Re-bleed." Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology, vol. 37, no. 2, 2018, pp. 153-159.
Mukkada RJ, Antony R, Chooracken MJ, et al. Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed. Indian J Gastroenterol. 2018;37(2):153-159.
Mukkada, R. J., Antony, R., Chooracken, M. J., Francis, J. V., Chettupuzha, A. P., Mathew, P. G., Augustine, P., & Koshy, A. (2018). Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed. Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology, 37(2), 153-159. https://doi.org/10.1007/s12664-018-0844-y
Mukkada RJ, et al. Endoscopic Ultrasound-guided Coil or Glue Injection in Post-cyanoacrylate Gastric Variceal Re-bleed. Indian J Gastroenterol. 2018;37(2):153-159. PubMed PMID: 29629510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed. AU - Mukkada,Roy J, AU - Antony,Rajesh, AU - Chooracken,Mathew J, AU - Francis,Jose V, AU - Chettupuzha,Antony P, AU - Mathew,Pradeep G, AU - Augustine,Philip, AU - Koshy,Abraham, Y1 - 2018/04/09/ PY - 2017/12/12/received PY - 2018/03/10/accepted PY - 2018/4/10/pubmed PY - 2018/8/28/medline PY - 2018/4/10/entrez KW - EUS-guided coil application KW - N-butyl-cyanoacrylate injection KW - Portal hypertension KW - Post-cyanoacrylate gastric variceal re-bleed SP - 153 EP - 159 JF - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology JO - Indian J Gastroenterol VL - 37 IS - 2 N2 - BACKGROUND AND AIMS: N-butyl-cyanoacrylate injection is recommended in bleeding/recently bled gastric varices. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. The aim of this study was to compare EUS-guided coil application combined with or without cyanoacrylate glue injection to injection alone in post-glue gastric variceal re-bleed. METHODS: A retrospective analysis of a prospectively maintained database was performed. Thirty patients who re-bled after cyanoacrylate injection and who had EUS-guided coil application to gastric varices were included. The comparison was done with data of 51 patients who had only repeat cyanoacrylate injection. Both groups had a follow up for 12 months. EUS-guided coil application was done under endosonographic guidance. A single coil was placed in 7, two coils in each of 13 patients, three in 5, four in 3, five in one, and 6 coils in one patient. In addition, cyanoacrylate glue injection was given in 15 patients. Eight patients had repeat EUS-guided coil application 1 month later. Re-bleed and mortality were assessed. RESULTS: Coilng: Six out of 30 (20%) patients re-bled during follow up of 9 to 365 days. Three out of 30 (10%) died. One patient died 9 days after the procedure due to acute respiratory distress syndrome, one died 4 months after the procedure due to a re-bleed and one 5 months after the procedure due to spontaneous bacterial peritonitis. Glue only: 26/51 (51%) re-bled during follow up of 45 to 365 days. EUS-guided coil application resulted in significantly less re-bleed than glue-only (Kaplan-Meir survival analysis with log-rank test, z = 5.4, p < 0.001). Two out of 51 (4%) died 59 and 186 days after the procedure. CONCLUSION: EUS-guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed. SN - 0975-0711 UR - https://www.unboundmedicine.com/medline/citation/29629510/Endoscopic_ultrasound_guided_coil_or_glue_injection_in_post_cyanoacrylate_gastric_variceal_re_bleed_ L2 - https://dx.doi.org/10.1007/s12664-018-0844-y DB - PRIME DP - Unbound Medicine ER -