Endoscopic injection sclerotherapy versus N-Butyl-2 Cyanoacrylate injection in the management of actively bleeding esophageal varices: a randomized controlled trial

Abstract

BackgroundThe management of acute esophageal variceal bleeding remains a clinical challenge. Band ligation is the main therapeutic option, but it may be technically difficult to perform in active bleeders. This may necessitate an alternative therapy for this group of patients. This study was conducted to assess the safety and efficacy of sclerotherapy versus cyanoacrylate injection for management of actively bleeding esophageal varices in cirrhotic patients.MethodsThis prospective study included 113 cirrhotic patients with actively bleeding esophageal varices. They were randomly treated by endoscopic sclerotherapy or cyanoacrylate injection as banding was not suitable for those patients due to profuse bleeding making unclear endoscopic visual field. Primary outcome was incidence of active bleeding control and secondary outcomes were incidence of six weeks rebleeding, complications, and mortality among the studied patients.ResultsInitial bleeding control was significantly higher in cyanoacrylate versus sclerotherapy groups (98.25, 83.93% respectively, P = 0.007). No significant differences between sclerotherapy and cyanoacrylate groups regarding rebleeding (26.79, 19.30% respectively, P = 0.344), complications, hospital stay or mortality rate were observed.ConclusionsBased on this single-center prospective study, both of these therapies appear to have relatively favorable outcomes, although cyanoacrylate injection may be superior to sclerotherapy for initial control of active bleeding.Trial registration[ClinicalTrials.gov Identifier:NCT03388125]–Date of registration: January 2, 2018 “Retrospectively registered”.

Ectopic duodenal variceal bleed successfully treated with TIPS and 2 years follow-up: A Case Report

“…EIS and EVL are the major endoscopic interventions for duodenal variceal bleed [13] . EIS is the treatment of acute variceal bleeding and prevention of rebleeding by endoscopic injection of sclerosing agent [14] . However, the veins passing through the duodenum are tributaries or common tributaries of the portal vein and the retroperitoneal vena cava, some of which can flow into the inferior vena cava or right renal vein [15] .…”

Second urgent endoscopy within 48-hour benefits cirrhosis patients with acute esophageal variceal bleeding

“…The methods of endoscopic hemostasis included variceal band ligation, endoscopic injection sclerotherapy or tissue adhesive injection therapy. Ligation or sclerotherapy is the recommended endoscopic therapy for acute EVB, [ 6 – 7 ] and endoscopic therapy with tissue adhesive is recommended for acute bleeding from isolated gastric varices (IGV) and those gastroesophageal varices type 2 (GOV2) that extend beyond the cardia. The ligature is 6 bursts of ligatures (COOK, USA), the sclerotherapy (either 10 ml/branch, lauromacrogel Shanxi Tianyu, China or 2 ml/branch, sodium smorrhuate injection Xinyi, China) using a combined intravariceal and paravariceal technique, the injection site is located at the cardia end of the varicose vein where the bleeding is local or hemorrhage.…”

The place of endoscopy in the tactics of restoring the viability of patients with gastroesophageal bleeding in portal hypertension (literature review)

“…К другим, менее используемым методам эндоскопического гемостаза относят облитерация тканевыми клеями [54], так как, по мнению многих авторов, эта техника является технически наиболее сложной, и она показала высокий уровень рецидива (47%) с частотой осложнений равной 10%, [2; 26;55].…”