Clin Mol Hepatol.  2016 Dec;22(4):487-494. 10.3350/cmh.2016.0050.

Cyanoacrylate injection versus band ligation for bleeding from cardiac varices along the lesser curvature of the stomach

• Park SJ
• Kim YK
• Seo YS
• Park SW
• Lee HA
• Kim TH
• Suh SJ
• Jung YK
• Kim JH
• An H
• Yim HJ
• Jang JY
• Yeon JE
• Byun KS

• KMID: 2373153
• DOI: http://doi.org/10.3350/cmh.2016.0050

Abstract

BACKGROUND/AIMS
Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1.
METHODS
Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded.
RESULTS
The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001).
CONCLUSIONS
Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1.

Keyword

Varices; Liver cirrhosis; Endoscopy; Cyanoacrylate; Band ligation

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/complications
Cyanoacrylates/*therapeutic use
Disease-Free Survival
Endoscopy, Gastrointestinal
Female
Gastrointestinal Hemorrhage/etiology/mortality/*therapy
Humans
Ligation
Liver Cirrhosis/complications/diagnosis
Liver Neoplasms/complications
Male
Middle Aged
Proportional Hazards Models
Recurrence
Retrospective Studies
Sclerotherapy
Survival Rate
Treatment Outcome
Cyanoacrylates