Successful endoscopic obturation of gastric varices with butyl cyanoacrylate

Ramond, Marie-José; Valla, Dominique; Mosnier, Jean‐François; Degott, Claude; Bernuau, Jacques; Rueff, B; Benhamou, Jean‐Pierre

doi:10.1002/hep.1840100415

Cited by 156 publications

(92 citation statements)

References 15 publications

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“…2,32 The success rate to control GVH by endoscopic injection of N-butyl-2-cyanoacrylate (GVO) appeared higher than other sclerosants according to previous non-randomized trials. 8,9 The advantage of endoscopic variceal ligation for EVH has been documented and has been suggested as the treatment of choice for EVH. 10 The hematostatic effect of endoscopic variceal ligation (GVL) for GVH appeared promising, but evidence is still limited.…”

Section: Discussionmentioning

confidence: 99%

“…GVH was diagnosed using the following: (1) clinical signs of hematemesis, coffee ground vomitus, hematochezia, or melena; (2) endoscopic signs of an active spurting or oozing from the GV; (3) adherent blood clots, white nipple signs, or erosions on the GV; or (4) in the presence of distinct large GV with a red-color sign and absence of EV and other bleeding sources. 8,12,14,15 Cases with concomitant large GV and large EV, but without stigmata of recent bleeding, were not enrolled in this study, because the exact bleeder could not be differentiated. Informed consent from the patients or their families was obtained.…”

Section: Methodsmentioning

confidence: 99%

“…The success rate in controlling GVH by endoscopic injection of N-butyl-2-cyanoacrylate (GVO) appears higher than for other sclerosants according to previous non-randomized trials. 8,9 Though endoscopic variceal ligation is regarded as the optimal endoscopic treatment for EVH, 10 its safety and efficacy for the treatment of GVH is uncertain. 7,11 The rebleeding rate of GVO is variable and ranges from 10% to 42%.…”

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A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage

et al. 2006

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Progression of gastric variceal hemorrhage (GVH) is poorer than esophageal variceal bleeding. However, data on its optimal treatment are limited. We designed a prospective study to compare the efficacy of endoscopic band ligation (GVL) and endoscopic N-butyl-2-cyanoacrylate injection (GVO). Liver patients with cirrhosis with or without concomitant hepatocellular carcinoma (HCC) and patients presenting with acute GVH were randomized into two treatment groups. Forty-eight patients received GVL, and another 49 patients received GVO. Both treatments were equally successful in controlling active bleeding (14/15 vs. 14/15, P ‫؍‬ 1.000). More of the patients who underwent GVL had GV rebleeding (GVL vs. GVO, 21/48 vs. 11/49; P ‫؍‬ .044). The 2-year and 3-year cumulative rate of GV rebleeding were 63.1% and 72.3% for GVL, and 26.8% for both periods with GVO; P ‫؍‬ .0143, log-rank test. The rebleeding risk of GVL was sustained throughout the entire follow-up period. Multivariate Cox regression indicated that concomitance with HCC (relative hazard: 2.453, 95% CI: 1.036-5.806, P ‫؍‬ .041) and the treatment method (GVL vs. GVO, relative hazard: 2.660, 95% CI: 1.167-6.061, P ‫؍‬ .020) were independent factors predictive of GV rebleeding. There was no difference in survival between the two groups. Severe complications attributable to these two treatments were rare. In conclusion, the efficacy of GVL to control active GVH appears not different to GVO, but GVO is associated with a lower GV rebleeding rate. (HEPATOLOGY 2006;43:690-697.) A lthough the outcome of variceal hemorrhage has improved over the past two decades, variceal hemorrhage is still the most serious complication of portal hypertension and chronic liver disease. 1 Although bleeding occurs less often from gastric varices (GV) than from esophageal varices (EV) (esophageal variceal hemorrhage [EVH] accounts for 70% to 80% of variceal hemorrhage), it has a poorer prognosis and is associated with more severe blood loss, a higher rebleeding rate, and a higher mortality rate. 1-3 However, limited data exist on the best treatment for GV hemorrhage (GVH). Endoscopic treatment is an alternative in the management of GVH and includes endoscopic injection of sclerosants or thrombin, 4,5 endoscopic band ligation, 6,7 and others. The success rate in controlling GVH by endoscopic injection of N-butyl-2-cyanoacrylate (GVO) appears higher than for other sclerosants according to previous non-randomized trials. 8,9 Though endoscopic variceal ligation is regarded as the optimal endoscopic treatment for EVH, 10 its safety and efficacy for the treatment of GVH is uncertain. 7,11 The rebleeding rate of GVO is variable and ranges from 10% to 42%. 12 At the time we started this trial, there were no randomized control trials, and even now, there is only one relatively small randomized clinical trial, 13 which was conducted to compare these two potential treatment modalities (endoscopic band ligation [GVL] vs. GVO) on the GVH; it showed results in favor of GVO for the treatment of GVH. We...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage

et al. 2006

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“…NBCA is radiolucent, and therefore, is usually mixed with radiopaque materials such as Lipiodol [66,91]. (2) Immediately before the injection of NBCA, the microcatheter should be thoroughly flushed with 5 % nonionic dextrose solution to completely remove any ionic solutions from its lumen [64,75,121,130,140,176]. The simultaneous perfusion of 5 % dextrose through the guiding catheter during the injection of NBCA delays contact with ionic substances and prolongs the polymerization period of NBCA [123,141].…”

Section: International Situationmentioning

confidence: 99%

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

et al. 2014

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“…EIS for gastric varices, although resulting in significantly improved hemostasis when using N-butyl-2-cyanoacrylate compared with other sclerosants, can result in bleeding from the injection site and rebleeding from the rupture site [76,[83][84][85][86]. Pulmonary, cerebral and coronary emboli may occur during cyanoacrylate injection of gastric varices [87,88].…”

Section: Recommendationsmentioning

confidence: 99%

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients. Experts predominantly from the Asia-Pacific region were requested to identify the different aspects of primary prophylaxis and develop the consensus guidelines. The APASL Working Party on Portal Hypertension evaluated the various therapies that have been used for the prevention of first variceal bleeding. A 2-day meeting was held on January 12 and 13, 2007, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and were subsequently presented at the annual conference of the APASL at Kyoto, Japan, in March 2007.

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Successful endoscopic obturation of gastric varices with butyl cyanoacrylate

Cited by 156 publications

References 15 publications

A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage

A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

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