Cost-Effectiveness of N-Butyl-2-Cyanoacrylate (Histoacryl) Glue Injections Versus Transjugular Intrahepatic Portosystemic Shunt in The Management of Acute Gastric Variceal Bleeding

Mahadeva, Sanjiv; Mc, Bellamy; Kessel, David; Davies, M; Millson, Charles

doi:10.1111/j.1572-0241.2003.08769.x

Cited by 121 publications

(81 citation statements)

References 23 publications

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“…Th e fi ndings of our single-center retrospective study confi rm results reported by Rengstorff et al ( 6 ) and Monsanto et al ( 7 ), where the use of cyanoacrylate injection is very eff ective in controlling gastric variceal bleeding with an acceptable safety profi le. Studies from China, Portugal, and the United States have reported rebleeding rates in the range of 4% to 14.4% (6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of 2-Octyl-Cyanoacrylate in the Management of Patients with Gastric and Duodenal Varices Who are Not Candidates for Transjugular Intrahepatic Portosystemic Shunts

Lizardo-Sanchez

Burdick

Trotter

2016

Baylor University Medical Center Proceedings

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Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension and cirrhosis. Options are limited for patients who are not candidates for transjugular intrahepatic portosystemic shunts (TIPS). Cyanoacrylate injections have been reported to be efficacious in previous case series. The aim of this retrospective study was to report our single-center experience with the safety and efficacy of 2-octyl-cyanoacrylate in patients who were not TIPS candidates. Electronic medical records were reviewed for 16 patients who underwent a total of 18 esophagogastroduodenoscopies for acute gastric or duodenal variceal bleeding and secondary prophylaxis of gastric varices; 14 patients had cirrhosis with an average Model for End-Stage Liver Disease score of 16, and 2 patients had noncirrhotic portal hypertension. Primary endpoints of the study included early and delayed rebleeding rate, complications, and death or liver transplantation. The rebleeding rate (early or delayed) was 7%, and no complications were found. One death was reported (unrelated to the procedure). In conclusion, 2-octylcyanoacrylate is a safe and effective alternative for non-TIPS candidates who present with acute gastric variceal bleeding given its low rebleeding and complication rate. I n general, management of acute gastric variceal bleeding consists of a combination of pharmacological therapy (octreotide bolus, followed by infusion), endoscopic therapy (banding ligation in the case of gastroesophageal varices type 1), bridge therapy (balloon tamponade), and rescue therapy (transjugular intrahepatic portosystemic shunts [TIPS]) in cases of high risk of rebleed or refractory bleeding. However, patients with severe decompensation of liver disease or signifi cant thrombus of hepatic vasculature are not ideal candidates for TIPS or balloon-occluded retrograde transvenous obliteration ( 1, 2 ), therefore limiting their therapeutic options to the use of tissue glues. 2-Octyl-cyanoacrylate is a monomer that rapidly polymerizes when it comes into contact with weak bases (blood and water). Several trials have demonstrated a similar hemostasis rate compared with alcohol and ethanolamine, a lower rate of rebleeding compared with band ligation, and a reduced rebleeding rate compared with beta-blockers ( 3-5 ). However, most studies of cyanoacrylate have been performed outside of the United States, mainly in Asia and Europe. Th e purpose of our study was to report our experience with 2-octyl-cyanoacrylate in From the Divisions of Gastroenterology (Lizardo-Sanchez, Burdick) and Hepatology

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of 2-Octyl-Cyanoacrylate in the Management of Patients with Gastric and Duodenal Varices Who are Not Candidates for Transjugular Intrahepatic Portosystemic Shunts

Lizardo-Sanchez

Burdick

Trotter

2016

Baylor University Medical Center Proceedings

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“…Although the available literature on GV bleeding is not as robust as the one for EV, all studies comparing TIPS vs. cyanoacrylate in bleeding GV demonstrated a significantly higher success rate in the TIPS group, with a greater burden of HE in derived subjects [14,[115][116][117][118][119][120][121][122][123]; In patients with large gastro renal shunts and contraindications to TIPS (e.g. elderly patients or patients with refractory encephalopathy or more compromised liver function) BRTO may be considered for the treatment of GV bleeding [124][125][126][127][128].…”

Section: Tips Is Not Indicated For the Prophylaxis Of First Variceal mentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

130

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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“…18 Costeffective analyses comparing NBC injection with TIPS have suggested that NBC is a safe and effective treatment for gastric variceal bleeding that can be provided at a significantly lower cost compared with TIPS placement. 19,20 The usefulness of TIPS is also limited by its availability only in major centers. 17 Balloon occluded retrograde transvenous obliteration has been used successfully for GV obliteration, primarily in Japan, as an elective procedure, but is unsuitable for acute gastric variceal bleeding and requires the presence of a spontaneous gastro-renal shunt.…”

Section: Discussionmentioning

confidence: 99%

Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection

Sharma

Banka

Rawat

et al. 2013

Journal of Clinical and Experimental Hepatology

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Background: Gastric varices are found in patients with portal hypertension. Incidence of bleeding from gastric varices is relatively low, but tends to be more severe, and is associated with higher mortality than esophageal variceal bleeding. Aims and objectives: To compare the prevalence and types of gastric varices in cirrhosis versus extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. Methods: Eighty six patients presenting with bleeding from gastric varices between August 2010 and August 2011 were retrospectively analyzed. Results: Of 86 patients, 65% (n = 56) were cirrhotics and 35% (n = 30) had EHPVO. Distribution of types of gastric varices showed GOV1 in 14% (n = 8) of cirrhotics vs. 7% (n = 2) of EHPVO, GOV2 in 80% (n = 45) of cirrhotics vs. 53% (n = 16) of EHPVO, IGV1 in 40% (n = 12) of patients with EHPVO vs. 4% (n = 2) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 3.7 ± 2.58 ml over a median of 1 session (range: 1-8). The total volume of glue required was lower in cirrhotics (3.2 ± 2 ml vs. 4.7 ± 3.1 ml, p < 0.05) than in EHPVO patients. Twenty (36%) of cirrhotics required >1 sessions of glue injection as compared to 17 (57%) of EHPVO patients. Over mean follow up of 12 months, rebleeding (9% vs. 10%) and mortality (11% vs. 3%) were similar in patients with cirrhosis and EHPVO. Conclusions: In patients with bleeding from gastric varices, GOV2 is more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for gastric varix obturation. ( J CLIN EXP HEPATOL 2013;3:19-23)

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Cost-Effectiveness of N-Butyl-2-Cyanoacrylate (Histoacryl) Glue Injections Versus Transjugular Intrahepatic Portosystemic Shunt in The Management of Acute Gastric Variceal Bleeding

Abstract: In this comparable group of patients, cyanoacrylate glue injection was more cost effective than TIPS in the management of acute gastric variceal bleeding. A prospective, randomized trial would be required to confirm our analysis.

Cited by 121 publications

References 23 publications

Safety and Efficacy of 2-Octyl-Cyanoacrylate in the Management of Patients with Gastric and Duodenal Varices Who are Not Candidates for Transjugular Intrahepatic Portosystemic Shunts

Safety and Efficacy of 2-Octyl-Cyanoacrylate in the Management of Patients with Gastric and Duodenal Varices Who are Not Candidates for Transjugular Intrahepatic Portosystemic Shunts

Consensus conference on TIPS management: Techniques, indications, contraindications

Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection

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