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EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding.
Surg Endosc. 2019 06; 33(6):1837-1845.SE

Abstract

BACKGROUND

Endoscopic injection of cyanoacrylate into gastric varices may be performed by EUS-guided fine needle injection (EUS-FNI) or direct endoscopic injection (DEI). The aim of this study is to compare the rate of recurrent GV bleeding and adverse events between DEI and EUS-FNI for treatment of GV.

METHODS

In a single-center study, a retrospective cohort of patients with actively/recently bleeding or high-risk GV treated with DEI were compared with a prospective cohort of similar patients treated with EUS-FNI. Repeat endoscopy after index treatment was performed 3 months later or earlier if rebleeding occurred. The main outcomes assessed were rates of GV or overall rebleeding and adverse events.

RESULTS

Forty patients (mean age 57.2 ± 9.1 years, 73% male) and 64 patients (mean age 58.0 ± 12.5 years, 52% male) underwent DEI and EUS-FNI, respectively. Compared to the DEI group, the frequency of isolated gastric varices type 1 (IGV1) were higher (p < 0.001) but MELD scores were lower (p = 0.004) in the EUS-FNI group. At index endoscopy, EUS-FNI utilized a lower mean volume of cyanoacrylate (2.0 ± 0.8 mL vs. 3.3 ± 1.3 mL; p < 0.001) and injected a greater number of varices (1.6 ± 0.7 vs. 1.1 ± 0.4; p < 0.001) compared to DEI. Overall, GV rebleeding [5/57 (8.8%) vs. 9/38 (23.7%); p = 0.045] and non-GV-related gastrointestinal bleeding [7/64 (10.9%) vs. 11/40 (27.5%); p = 0.030] were less frequent in the EUS-FNI group compared to the DEI group, respectively. Adverse event rates were similar (20.3% vs. 17.5%, p = 0.723).

CONCLUSIONS

EUS-guided CYA injection of active or recently bleeding GV in patients with portal hypertension appears to decrease the rate of GV rebleeding despite injection of more varices and less CYA volume during the initial endoscopic procedure. Adverse events are similar between the two groups. EUS-FNI appears to be the preferred strategy for treatment of these patients.

Authors+Show Affiliations

Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA.Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA.Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA.Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA.Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA. jodewitt@iupui.edu.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

30259158

Citation

Bick, Benjamin L., et al. "EUS-guided Fine Needle Injection Is Superior to Direct Endoscopic Injection of 2-octyl Cyanoacrylate for the Treatment of Gastric Variceal Bleeding." Surgical Endoscopy, vol. 33, no. 6, 2019, pp. 1837-1845.
Bick BL, Al-Haddad M, Liangpunsakul S, et al. EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding. Surg Endosc. 2019;33(6):1837-1845.
Bick, B. L., Al-Haddad, M., Liangpunsakul, S., Ghabril, M. S., & DeWitt, J. M. (2019). EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding. Surgical Endoscopy, 33(6), 1837-1845. https://doi.org/10.1007/s00464-018-6462-z
Bick BL, et al. EUS-guided Fine Needle Injection Is Superior to Direct Endoscopic Injection of 2-octyl Cyanoacrylate for the Treatment of Gastric Variceal Bleeding. Surg Endosc. 2019;33(6):1837-1845. PubMed PMID: 30259158.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding. AU - Bick,Benjamin L, AU - Al-Haddad,Mohammad, AU - Liangpunsakul,Suthat, AU - Ghabril,Marwan S, AU - DeWitt,John M, Y1 - 2018/09/26/ PY - 2018/06/27/received PY - 2018/09/18/accepted PY - 2018/9/28/pubmed PY - 2020/4/24/medline PY - 2018/9/28/entrez KW - Cyanoacrylate KW - Endoscopic ultrasound KW - Fine needle injection KW - Gastric varices KW - Variceal bleeding SP - 1837 EP - 1845 JF - Surgical endoscopy JO - Surg Endosc VL - 33 IS - 6 N2 - BACKGROUND: Endoscopic injection of cyanoacrylate into gastric varices may be performed by EUS-guided fine needle injection (EUS-FNI) or direct endoscopic injection (DEI). The aim of this study is to compare the rate of recurrent GV bleeding and adverse events between DEI and EUS-FNI for treatment of GV. METHODS: In a single-center study, a retrospective cohort of patients with actively/recently bleeding or high-risk GV treated with DEI were compared with a prospective cohort of similar patients treated with EUS-FNI. Repeat endoscopy after index treatment was performed 3 months later or earlier if rebleeding occurred. The main outcomes assessed were rates of GV or overall rebleeding and adverse events. RESULTS: Forty patients (mean age 57.2 ± 9.1 years, 73% male) and 64 patients (mean age 58.0 ± 12.5 years, 52% male) underwent DEI and EUS-FNI, respectively. Compared to the DEI group, the frequency of isolated gastric varices type 1 (IGV1) were higher (p < 0.001) but MELD scores were lower (p = 0.004) in the EUS-FNI group. At index endoscopy, EUS-FNI utilized a lower mean volume of cyanoacrylate (2.0 ± 0.8 mL vs. 3.3 ± 1.3 mL; p < 0.001) and injected a greater number of varices (1.6 ± 0.7 vs. 1.1 ± 0.4; p < 0.001) compared to DEI. Overall, GV rebleeding [5/57 (8.8%) vs. 9/38 (23.7%); p = 0.045] and non-GV-related gastrointestinal bleeding [7/64 (10.9%) vs. 11/40 (27.5%); p = 0.030] were less frequent in the EUS-FNI group compared to the DEI group, respectively. Adverse event rates were similar (20.3% vs. 17.5%, p = 0.723). CONCLUSIONS: EUS-guided CYA injection of active or recently bleeding GV in patients with portal hypertension appears to decrease the rate of GV rebleeding despite injection of more varices and less CYA volume during the initial endoscopic procedure. Adverse events are similar between the two groups. EUS-FNI appears to be the preferred strategy for treatment of these patients. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/30259158/EUS_guided_fine_needle_injection_is_superior_to_direct_endoscopic_injection_of_2_octyl_cyanoacrylate_for_the_treatment_of_gastric_variceal_bleeding_ L2 - https://doi.org/10.1007/s00464-018-6462-z DB - PRIME DP - Unbound Medicine ER -