A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices

Authors

  • Gin-Ho Lo M.D.,

    Corresponding author
    1. From the Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China
    • Division of Gastroenterology, Department of Medicine, Veterans General Hospital, 386 Ta-Chung 1st. Road, Kaohsiung 813, Taiwan, Republic of China. fax: (886) 7-3468237.
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  • Kwok-Hung Lai,

    1. From the Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China
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  • Jin-Shiung Cheng,

    1. From the Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China
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  • Mei-Hsiu Chen,

    1. From the Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China
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  • Hung-Ting Chiang

    1. From the Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Abstract

Gastric variceal bleeding is a catastrophic event. Both cyanoacrylate injection and banding ligation have been proven to be effective in the management of bleeding gastric varices. This study was performed to compare the efficacy and complications of both the modalities. Cirrhotic patients with a history of gastric variceal bleeding were randomized to 2 groups. The group receiving endoscopic obturation (group A) comprised 31 patients and the group receiving band ligation (group B) comprised 29 patients. Butyl cyanoacrylate and pneumatic-driven ligator were applied, respectively. Treatment was repeated regularly until obliteration of gastric varices. Active bleeding occurred in 15 patients in group A and 11 patients in group B. Initial hemostatic rate (defined as no bleeding for 72 hours after treatment) was 87% in group A and 45% in group B (P = .03). The sessions required to achieve variceal obliteration and obliteration rates were similar in both the groups. However, rebleeding rates were significantly higher in group B (54%) than group A (31%) (P = .0005). Treatment-induced ulcer bleeding occurred in 2 patients (7%) in group A and 8 patients (28%) in group B (P = .03). The amount of blood transfusions required were also higher in group B than group A (4.2 ± 1.3 vs. 2.6 ± 0.9 units, respectively) (P < .01). Nine patients of group A and 14 patients of group B died (P = .05). In conclusion, endoscopic obturation using cyanoacrylate proved more effective and safer than band ligation in the management of bleeding gastric varices.

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