Evrard S, Dumonceau J-M, Delhaye M, Golstein P, Devière J, Le Moine O
Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
Endoscopy. 2003 Sep;35(9):729-35. doi: 10.1055/s-2003-41581.
The obliteration of esophageal and/or gastric varices using Histoacryl is highly effective in controlling active bleeding. However, it is not known whether repeated injections are useful for the long-term eradication of esophagogastric varices. The aim of the study was to compare endoscopic Histoacryl obliteration with propranolol in the secondary prevention of esophagogastric variceal bleeding.
Between August 1995 and February 1999, 41 patients with a first bleeding from esophageal (n = 31) or gastric (n = 10) varices were included in the study. After primary hemostasis with obliteration using Histoacryl, patients were randomly allocated either to undergo complete Histoacryl obliteration of the remaining varices (group A, n = 21) or to long-term propranolol administration (group B, n = 20), for the prevention of rebleeding.
The two groups were well matched for age, sex, etiology of cirrhosis, Child-Pugh score, renal function, and infection at the time of admission. The median follow-up was 31.9 months (4.8 - 74.7) for group A and 23.2 months (3.0 - 70.0) for group B. Initial hemostasis was achieved in 40/41 patients (97 %). No significant difference was observed between groups A and B with regard to the incidence of early rebleeding (during the first 6 weeks; 5/21 and 3/20), bleeding-related deaths by 6 weeks (3/21 and 6/20), long-term rebleeding (11/21 and 5/20), or overall number of deaths (9/21 and 9/20). The incidence of complications was higher in group A (10/21) than group B (2/20) (P < 0.03).
Repeated injections of Histoacryl with the aim of eradicating esophagogastric varices are associated with more complications compared with beta-blocker administration, with similar results in terms of rebleeding rate and survival in the long term.
使用组织黏合剂闭塞食管和/或胃静脉曲张在控制活动性出血方面非常有效。然而，重复注射对于食管胃静脉曲张的长期根除是否有用尚不清楚。本研究的目的是比较内镜下组织黏合剂闭塞术与普萘洛尔在食管胃静脉曲张出血二级预防中的效果。
1995年8月至1999年2月，41例首次发生食管（n = 31）或胃（n = 10）静脉曲张出血的患者纳入研究。使用组织黏合剂闭塞术实现初步止血后，患者被随机分配接受剩余静脉曲张的完全组织黏合剂闭塞术（A组，n = 21）或长期服用普萘洛尔（B组，n = 20），以预防再出血。
两组在年龄、性别、肝硬化病因、Child-Pugh评分、肾功能及入院时感染情况方面匹配良好。A组的中位随访时间为31.9个月（4.8 - 74.7），B组为23.2个月（3.0 - 70.0）。40/41例患者（97%）实现了初始止血。A组和B组在早期再出血发生率（前6周内；5/21和3/20）、6周时与出血相关的死亡率（3/21和6/20）、长期再出血率（11/21和5/20）或总死亡人数（9/21和9/20）方面均未观察到显著差异。A组的并发症发生率（10/21）高于B组（2/20）（P < 0.03）。
旨在根除食管胃静脉曲张的组织黏合剂重复注射与β受体阻滞剂治疗相比，并发症更多，在再出血率和长期生存率方面结果相似。
