The use of thrombin injections in the management of bleeding gastric varices: a single-center experience.

BACKGROUND

There is a relative dearth of literature on the definitive endoscopic management of bleeding gastric varices. Variceal ligation with bands and detachable snares, sclerosants, cyanoacrylate glue, and thrombin injections have been used with variable success.

OBJECTIVE

To report our experience with bovine thrombin injection for the treatment of bleeding gastric varices.

DESIGN

A retrospective review.

SETTING

Tertiary-referral hospital.

PATIENTS

Forty-two cases of gastric varices were identified from our endoscopy database between July 1998 and July 2003. Thirteen patients had thrombin injection.

INTERVENTION

Thrombin injection therapy for bleeding gastric varices.

MAIN OUTCOME MEASUREMENTS

Control of hemorrhage, risk of rebleeding, and mortality.

RESULTS

Of the 13 patients who underwent thrombin injections, hemostasis in the acute setting was successful in 92% of cases. Patients received 1 to 4 sessions of thrombin, with a mean total dose of 10.8 mL for variceal eradication. One patient continued to bleed and needed a transjugular intrahepatic portosystemic shunt as a rescue procedure. The patient with hepatocellular carcinoma died within 30 days, and 4 more patients died after a median follow-up of 22 months; none died because of bleeding. There was no rebleeding in the remaining patients at a median follow-up of 25 months.

LIMITATIONS

The retrospective nature and small number.

CONCLUSIONS

In our series, injection with thrombin proved to be an effective endoscopic treatment in the majority of patients with bleeding gastric varices. The overall mortality, after controlling bleeding, was 38% (5/13), subsequent to a median follow-up of 22 months.