A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL

Risk factors of early re-bleeding and mortality in patients with ruptured gastric varices and concomitant hepatocellular carcinoma

“…GVB was confirmed using emergent endoscopy on the basis of previously published criteria [5]. Endoscopic treatment was performed using cyanoacrylate injection or ligation according to our previously published techniques [5,6]. If the patients were amenable to maintenance treatment, endoscopic treatment of the gastric varice (GV) was regularly performed every 3-4 weeks until the GV was obliterated.…”

“…Although the risk factors of 5-day re-bleeding and 6-week mortality for variceal hemorrhage are defined in the Baveno V Consensus, most of the studies conducted to date on prognostic factors for re-bleeding and mortality after a variceal hemorrhage have either excluded HCC patients or comprised only a few such patients [14][15][16]. In our earlier studies, HCC was found to be a risk factor for re-bleeding in GVB patients [5,6], which evoked our interest on the impact of different HCC characteristics on the re-bleeding in GVB patients. To date, however, the effect of HCC characteristics on re-bleeding and mortality after a variceal hemorrhage has not been determined.…”

“…In general, gastric variceal bleeding (GVB) is more severe and requires more transfusions than esophageal variceal hemorrhage [1]. Using an endoscopic tissue glue injection procedure, the mortality and re-bleeding rates of GVB are 10-62% [2][3][4][5][6] and 22-37% [2,[5][6][7], respectively. Although the prognosis of esophageal variceal hemorrhage has improved over the past few decades [8,9], the clinical outcome of GVB is still far from satisfactory.…”

“…In the study reported here, we retrospectively evaluated data on patients with GVB and concomitant HCC compiled in prospectively collected databases [5,6,22]. We investigated the clinical characteristics, relevant laboratory data, tumor patterns, cancer stage, and chronological relationship between the development of HCC and GVB to determine the risk factors for 5-day re-bleeding and 30-day and 5-year survival in patients with acute GVB and concomitant HCC.…”

Large Silent Gastric Fundal Varices in Cirrhotic Patients: Role of Abdominal Multidetector Triphasic Computed Tomography.

“…Compared with esophageal variceal bleeding, haemorrhage caused by fundal varices, although less frequent, is more severe and haemostatic control is more difficult with reported mortality of approximately 45% [6,7]. Even after standard endoscopic management, GV bleeding is still associated with high rebleeding rates, ranging from 22% to 37% [8,9]. Although the prognosis of esophageal variceal hemorrhage has improved over the past few decades [10,11], the clinical outcome of gastric variceal bleeding is still far from satisfactory [12].…”