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

The Korean Journal of Internal Medicine 2014년 29권 4호 p.437 ~ p.444

전충환(Jun Chung-Hwan) - Chonnam National University Medical School Department of Internal Medicine
(Kim Ka-Rham) - Chonnam National University Medical School Department of Internal Medicine
윤재현(Yoon Jae-Hyun) - Chonnam National University Medical School Department of Internal Medicine
(Koh Han-Ra) - Chonnam National University Medical School Department of Internal Medicine
최원석(Choi Won-Suk) - Chonnam National University Medical School Department of Internal Medicine
조규만(Cho Kyu-Man) - Chonnam National University Medical School Department of Internal Medicine
(Lim Sung-Uk) - Chonnam National University Medical School Department of Internal Medicine
박창환(Park Chang-Hwan) - Chonnam National University Medical School Department of Internal Medicine
주영은(Joo Young-Eun) - Chonnam National University Medical School Department of Internal Medicine
김현수(Kim Hyun-Soo) - Chonnam National University Medical School Department of Internal Medicine
최성규(Choi Sung-Kyu) - Chonnam National University Medical School Department of Internal Medicine
류종선(Rew Jong-Sun) - Chonnam National University Medical School Department of Internal Medicine

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.