Document Detail


Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial.
MedLine Citation:
PMID:  20551457     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: Bleeding from gastric varices is often severe and difficult to manage. Endoscopic injection of gastric varices with cyanoacrylate is effective in prevention of rebleeding. The efficacy of beta-blockers in secondary prophylaxis of gastric variceal bleed has not been well studied. A comparison of the efficacy of beta-blocker treatment and cyanoacrylate injection for the prevention of gastric variceal rebleeding was carried out. METHODS: Patients with gastro-oesophageal varices type 2 (GOV2) with eradicated oesophageal varices or isolated gastric varices type 1 (IGV1) who had bled from gastric varices were randomised to cyanoacrylate injection (n=33) or beta-blocker treatment (n=34). Baseline and follow-up upper gastrointestinal endoscopy and hepatic venous pressure gradient (HVPG) measurements were performed. Primary end points were gastric variceal rebleeding or death. RESULTS: The probability of gastric variceal rebleeding rate in the cyanoacrylate group was significantly lower than in the beta-blocker group (15% vs 55%, p=0.004) and the mortality rate was lower (3% vs 25%, p=0.026) during a median follow-up of 26 months. The median baseline and follow-up HVPG in the cyanoacrylate group were 15 (10-23) and 17 (11-24) mm Hg (p=0.001) and for the beta-blocker group 14 (11-24) and 13 (8-25) mm Hg (p=0.003). While no patient showed reduction of HVPG in the cyanoacrylate group, in the beta-blocker group 12 of 28 (42%) patients were responders, of which 5 (41% of responders) bled. On multivariate analysis, treatment method, portal hypertensive gastropathy and size of the gastric varix >20 mm independently correlated with gastric variceal rebleeding. Gastric variceal rebleeding independently correlated with mortality. CONCLUSIONS: Cyanoacrylate injection is more effective than beta-blocker treatment for the prevention of gastric variceal rebleeding and improving survival.
Authors:
Smruti Ranjan Mishra; Barjesh Chander Sharma; Ashish Kumar; Shiv Kumar Sarin
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  59     ISSN:  1468-3288     ISO Abbreviation:  Gut     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-16     Completed Date:  2010-07-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  729-35     Citation Subset:  AIM; IM    
Affiliation:
Department of Gastroenterology, G B Pant Hospital, 201 Academic Block, New Delhi 110002, India.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00888784
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic beta-Antagonists / adverse effects,  therapeutic use*
Adult
Aged
Child
Cyanoacrylates / adverse effects,  therapeutic use*
Embolization, Therapeutic / adverse effects,  methods*
Endoscopy, Gastrointestinal / methods
Esophageal and Gastric Varices / complications,  pathology,  physiopathology,  therapy*
Female
Gastrointestinal Hemorrhage / etiology,  physiopathology,  prevention & control*
Hepatic Veins / physiopathology
Humans
Male
Middle Aged
Prognosis
Propranolol / adverse effects,  therapeutic use
Recurrence
Risk Factors
Survival Analysis
Tissue Adhesives / adverse effects,  therapeutic use*
Treatment Outcome
Venous Pressure / physiology
Young Adult
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Cyanoacrylates; 0/Tissue Adhesives; 525-66-6/Propranolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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