Clinical outcomes of gastric variceal obliteration using N-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

Chung Hwan Jun, Ka Rham Kim, Jae Hyun Yoon, Han Ra Koh, Won Suk Choi, Kyu Man Cho, Sung Uk Lim, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew, Chung Hwan Jun, Ka Rham Kim, Jae Hyun Yoon, Han Ra Koh, Won Suk Choi, Kyu Man Cho, Sung Uk Lim, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew

Abstract

Background/aims: To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices.

Methods: We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients' endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding-related death rates were reviewed.

Results: Hemostasis was achieved initially in 96.9% (441/455) of patients; rebleeding occurred in 35.2% (160/455), and the bleeding-related death rate was 6.8% (31/455) during follow-up. Complications included fever (6.8%), abdominal pain (3.7%), diarrhea (1.3%), spontaneous bacterial peritonitis (0.7%), bacteremia (0.4%), and embolism (0.2%). A red-color sign on concomitant esophageal varices (EVs) (p = 0.002) and previous history of variceal bleeding (p < 0.001) were significant risk factors for rebleeding within 1 year. The Child-Pugh score (p < 0.001), presence of hepatocellular carcinoma (p = 0.001), and failure of initial hemostasis (p < 0.001) were the risk factors most closely associated with bleeding-related death.

Conclusions: This study provides a comprehensive overview of the outcomes and prognostic factors of patients with GVH. The results may help in the selection of effective treatment strategies for patients with GVH.

Keywords: Cyanoacrylates; Endoscopy; Esophageal and gastric varices; Hemostasis; Treatment outcome.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Kaplan-Meyer analysis of bleeding-related deaths according to Child-Pugh classification by log-rank test (p < 0.001). CPT, Child-Pugh-Turcott.
Figure 2
Figure 2
Kaplan-Meyer analysis of bleeding-related deaths according to the absence or presence of hepatocellular carcinoma (HCC) by log-rank test (p < 0.001).
Figure 3
Figure 3
Kaplan-Meyer analysis of bleeding-related deaths according to success or failure of initial hemostasis by log-rank test (p < 0.001).

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