Introduction Endoscopic Human Thrombin injection appears a technically simple yet efficacious alternative to cyanoacrylate for gastric varices with fewer complications from studies to date, but data remains limited. We evaluated the outcomes of patients following single thrombin injection treatment for acute bleeding from oesophageal and gastric varices.
Methods Retrospective review of patients receiving endoscopic human thrombin injection (Tisseel Baxter Intl Inc.) for active bleeding from varices at a UK centre 2011–2012.
Results 15 patients (67% male, mean age 56 (SD 10)), received human thrombin injection for actively bleeding varices. Mechanism of portal hypertension was alcoholic cirrhosis in 12 patients (80%), extra-hepatic in 3 (20%). Extrahepatic portal hypertension was due to cancer, portal vein thrombosis and splenic vein thrombosis respectively. Mean MELD was 15 (SD 6). Childs grade was A, B, C in 6%, 47% and 47% respectively. Bleeding varices were identified as gastric in 13 patients (87%), oesophageal in 2 (13%). These 2 cases were not amenable to further banding due to band-induced fibrosis. Gastric varices were classified as: GOV1 4 (31%), GOV2 6 (46%), IGV1 3(31%). There were co-existing oesophageal varices in 9 of 13 (69%), of which 3 were banded in addition but not actively bleeding. Mean thrombin dose used was 1125IU (range 500–2000). Immediate haemostasis was achieved in all 15 cases. Propanolol was commenced post endoscopy in 14 (93%) patients and maintained at a mean dose of 80mg/day (SD 35, range 20–160).
Median follow up time was 129 days (range 9–753). No patient received TIPSS or liver transplantation. Rebleeding occurred in 3 (20%) patients, at 14, 43 and 299 days respectively. All 3 patients died following rebleeding (2 declined treatment, 1 pre-hospital arrest). There were 7 deaths in total during the study period, the remainder due to liver failure (2), pneumonia (1), metastatic cancer (1). Cumulative survival at 1, 3, 6, 12 months was 73%, 59%, 59%, and 50% respectively.
Conclusion Single dose thrombin injection in our series appears to be a safe, easily administered and effective endoscopic therapy for acutely bleeding oesophagogastric varices. Mortality however remains high due to their underlying liver disease.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.