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Long-term Outcomes of Acute Gastric Variceal Bleeding in 48 Patients Following Treatment with Cyanoacrylate

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Abstract

Objectives

(1) Study the effectiveness of intravariceal injection of n-butyl-2-cyanoacrylate to treat acute gastric variceal (GV) bleeding and (2) study the impact of the type of GV and hepatic function on endoscopic hemostasis and mortality outcomes.

Methods

Fourty-eight patients with acute GV bleeding underwent intravariceal injection of n-butyl-2-cyanoacrylate and were followed until death or study conclusion (12–52 months).

Results

Primary hemostasis (no re-bleeding within 48 h) was accomplished in 42 patients (87.5%). Appearance of the bleeding site at the time of initial endoscopy, grade of cirrhosis and location of GV were not significant predictors of immediate hemostasis. Early re-bleeding (48 h to 6 weeks) occurred in 20.5% of patients and late re-bleeding (beyond 6 weeks) in 20.5% of patients. While the Child-Pugh score was predictive of re-bleeding and mortality, the type of GV and stigmata at initial endoscopy were not significant predictors of re-bleeding and mortality. Over a mean follow-up of 18 months, mortality rates were 43.9% and bleeding was the commonest cause of death.

Conclusion

Endoscopic injection of n-butyl-2-cyanoacrylate is effective and safe for treating bleeding GV. Patients with poor hepatic function are at higher risk of re-bleeding and death after acute gastric variceal bleed.

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Acknowledgements

We thank Dr. Alan Barkun, Director, Division of Gastroenterology, McGill University, Canada, for his invaluable suggestions and careful review of the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, Gastrointestinal Endoscopy Division, University of São Paulo School of Medicine, Sao Paulo, Brazil

    Petruska Marques, Fauze Maluf-Filho, Sergio E. Matuguma, Paulo Sakai & Shinichi Ishioka

  2. Division of Gastroenterology and Hepatology, Northport VA Medical Center & Stony Brook University, 79 Middleville Road, Northport, NY, 11768, USA

    Atul Kumar

Authors
  1. Petruska Marques
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  2. Fauze Maluf-Filho
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  3. Atul Kumar
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  4. Sergio E. Matuguma
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  5. Paulo Sakai
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  6. Shinichi Ishioka
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Corresponding author

Correspondence to Atul Kumar.

Additional information

Petruska Marques, Fauze Maluf-Filho and Atul Kumar contributed equally to the article.

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Marques, P., Maluf-Filho, F., Kumar, A. et al. Long-term Outcomes of Acute Gastric Variceal Bleeding in 48 Patients Following Treatment with Cyanoacrylate. Dig Dis Sci 53, 544–550 (2008). https://doi.org/10.1007/s10620-007-9882-5

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  • DOI: https://doi.org/10.1007/s10620-007-9882-5

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