The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical outcomes of gastric variceal obliteration using N-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

  • Jun, Chung Hwan (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Ka Rham (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Yoon, Jae Hyun (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Koh, Han Ra (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Choi, Won Suk (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Cho, Kyu Man (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Sung Uk (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Park, Chang Hwan (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Joo, Young Eun (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Hyun Soo (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Choi, Sung Kyu (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Rew, Jong Sun (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2013.09.29
  • Accepted : 2013.12.03
  • Published : 2014.07.01
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Abstract

Background/Aims: To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices. Methods: We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients' endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding-related death rates were reviewed. Results: Hemostasis was achieved initially in 96.9% (441/455) of patients; rebleeding occurred in 35.2% (160/455), and the bleeding-related death rate was 6.8% (31/455) during follow-up. Complications included fever (6.8%), abdominal pain (3.7%), diarrhea (1.3%), spontaneous bacterial peritonitis (0.7%), bacteremia (0.4%), and embolism (0.2%). A red-color sign on concomitant esophageal varices (EVs) (p = 0.002) and previous history of variceal bleeding (p < 0.001) were significant risk factors for rebleeding within 1 year. The Child-Pugh score (p < 0.001), presence of hepatocellular carcinoma (p = 0.001), and failure of initial hemostasis (p < 0.001) were the risk factors most closely associated with bleeding-related death. Conclusions: This study provides a comprehensive overview of the outcomes and prognostic factors of patients with GVH. The results may help in the selection of effective treatment strategies for patients with GVH.

Keywords

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