Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices

Lee, Moon Sung; Cho, Joo Young; Cheon, Young Koog; Ryu, Chang Beom; Moon, Jong Ho; Cho, Young Deok; Kim, Jin Oh; Kim, Yun Soo; Lee, Joon Seong; Shim, Chan Sup

doi:10.1067/mge.2002.125104

Cited by 50 publications

(31 citation statements)

References 19 publications

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“…To set a conclusion of equal efficacy in controlling active bleeding, a large case number trial based on active bleeding is needed. The success rate of GVL was also comparable to that of previous studies 6,7,36 but higher than the rate in Lo et al's study. 13 The difference in the success rates of bleeding control between studies may be attributable to different technical applications.…”

Section: Discussionsupporting

confidence: 85%

“…In comparison with previous studies, 6,7,33,34 this study has three important distinguishing features. First, it is the second If the portal hypertension related rebleeding source (esophageal varices, portal hypertensive gastropathy, and other undetermined) was included, the rebleeding rate in the ligation group would still appear higher than in the injection group (GVL vs. GVO, 27/47 vs. 17/48, P ϭ .052).…”

Section: Discussionmentioning

confidence: 87%

“…10 The hematostatic effect of endoscopic variceal ligation (GVL) for GVH appeared promising, but evidence is still limited. 6,7 However, a relatively small randomized trial 13 was conducted to compare the efficacy of GVL versus GVO on GVH, and its conclusions were against the use of GVL for the treatment of GVH. More randomized trials are needed to clarify the best treatment methods.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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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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