| Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. | |
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MedLine Citation:
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PMID: 20551457 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Smruti Ranjan Mishra; Barjesh Chander Sharma; Ashish Kumar; Shiv Kumar Sarin |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Gut Volume: 59 ISSN: 1468-3288 ISO Abbreviation: Gut Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-16 Completed Date: 2010-07-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 2985108R Medline TA: Gut Country: England |
Other Details:
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Languages: eng Pagination: 729-35 Citation Subset: AIM; IM |
Affiliation:
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Department of Gastroenterology, G B Pant Hospital, 201 Academic Block, New Delhi 110002, India. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00888784 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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