Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Gastrointest Endosc. 2010 Oct;72(4):721-7. doi: 10.1016/j.gie.2010.06.015.
Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. N-butyl cyanoacrylate (NBC), mixed with lipiodol, has been shown to be effective in controlling bleeding, but is associated with the risk of distal embolization.
To study the efficacy and safety of undiluted NBC in the management of gastric varices (GV).
Prospective cohort study.
Single tertiary care center.
170 consecutive patients with GV.
Standardized technique of undiluted NBC injection for management of GV.
Achievement of initial hemostasis, rate of rebleeding, procedure-related complications, and mortality.
GV were identified in 170 patients, 87 of whom were treated with 261 injections of undiluted NBC. Among 46 patients with active bleeding of GV, initial hemostasis was achieved in 84.8%. Rebleeding was seen in 23.4% patients over a mean follow-up of 16 months. No case of clinical distal embolization was seen. Large GV size, fundal location, and large esophageal variceal size were predictive of GV bleed. The mortality was 8.8% for all patients with GV; 10.3% for patients with GV treated with NBC, and 7.2% for those with GV not treated with NBC. Child-Pugh status was the only predictor of mortality.
Only 1 intervention group.
Undiluted NBC is safe and effective in the management of gastric variceal bleeding.
胃静脉曲张出血与门脉高压患者的高发病率和高死亡率相关。已证实，混合了碘油的丁基氰基丙烯酸酯（NBC）在控制出血方面有效，但存在远端栓塞的风险。
研究未稀释 NBC 在胃静脉曲张（GV）治疗中的疗效和安全性。
前瞻性队列研究。
单一的三级保健中心。
170 例连续的 GV 患者。
标准化的未稀释 NBC 注射技术，用于 GV 管理。
初次止血的实现、再出血率、与操作相关的并发症和死亡率。
在 170 例患者中发现了 GV，其中 87 例接受了 261 次未稀释 NBC 注射治疗。在 46 例 GV 活动性出血的患者中，初始止血率为 84.8%。在平均 16 个月的随访中，有 23.4%的患者出现再出血。未发现临床远端栓塞的情况。大的 GV 大小、胃底位置和大的食管静脉曲张大小是 GV 出血的预测因素。所有 GV 患者的死亡率为 8.8%；接受 NBC 治疗的 GV 患者的死亡率为 10.3%，未接受 NBC 治疗的 GV 患者的死亡率为 7.2%。Child-Pugh 状态是唯一的死亡预测因素。
仅一个干预组。
未稀释 NBC 治疗胃静脉曲张出血是安全有效的。
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