Korean J Intern Med.  2015 Sep;30(5):593-601. 10.3904/kjim.2015.30.5.593.

Can proton pump inhibitors reduce rebleeding following Histoacryl sclerotherapy for gastric variceal hemorrhage?

• Kim KR
• Jun CH
• Cho KM
• Wi JW
• Park SY
• Cho SB
• Lee WS
• Park CH
• Joo YE
• Kim HS
• Choi SK
• Rew JS

• KMID: 2381557
• DOI: http://doi.org/10.3904/kjim.2015.30.5.593

Abstract

BACKGROUND/AIMS
To evaluate the efficacy of proton pump inhibitors (PPIs) in reducing rebleeding and bleeding-related death rates after endoscopic gastric variceal obliteration (GVO) using N-butyl-2-cyanoacrylate (NBC).
METHODS
This study enrolled 341 patients who were consecutively diagnosed with and treated for bleeding gastric varices. The patients were divided into PPI and non-PPI groups, and their endoscopic findings, initial hemostasis outcomes, rebleeding and bleeding-related death rates, and treatment-related complications were analyzed.
RESULTS
The rate of initial hemostasis was 97.1%. rebleeding occurred in 2.2% of patients within 2 weeks, 3.9% of patients within 4 weeks, 18.9% of patients within 6 months, and 27.6% of patients within 12 months of the GVO procedure. A previous history of variceal bleeding (relative risk [RR], 1.955; 95% confidence interval [CI], 1.263 to 3.028; p = 0.003) and use of PPIs (RR, 0.554; 95% CI, 0.352 to 0.873; p = 0.011) were associated with rebleeding. Child-Pugh class C (RR, 10.914; 95% CI, 4.032 to 29.541; p < 0.001), failure of initial hemostasis (RR, 13.329; 95% CI, 2.795 to 63.556; p = 0.001), and the presence of red-colored concomitant esophageal varices (RR, 4.096; 95% CI, 1.320 to 12.713; p = 0.015) were associated with bleeding-related death.
CONCLUSIONS
The prophylactic use of PPIs reduces rebleeding after GVO using NBC in patients with gastric variceal hemorrhage. However, prophylactic use of PPIs does not reduce bleeding-related death.

Keyword

Cyanoacrylates; Esophageal and gastric varices; Hemostasis; Endoscopic; Proton pump inhibitors; Treatment outcome

MeSH Terms

Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Enbucrilate/*administration & dosage/adverse effects
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/complications/diagnosis/mortality/*therapy
Female
Gastrointestinal Hemorrhage/diagnosis/etiology/mortality/*therapy
Hemostasis, Endoscopic/adverse effects/*methods/mortality
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Proton Pump Inhibitors/adverse effects/*therapeutic use
Recurrence
Retrospective Studies
Risk Factors
Sclerosing Solutions/*administration & dosage/adverse effects
Sclerotherapy/adverse effects/*methods/mortality
Time Factors
Treatment Outcome
Young Adult
Enbucrilate
Proton Pump Inhibitors
Sclerosing Solutions