Gubler Christoph, Bauerfeind Peter
Clinic of Gastroenterology and Hepatology, University Hospital of Zurich , Zurich , Switzerland.
Scand J Gastroenterol. 2014 Sep;49(9):1136-42. doi: 10.3109/00365521.2014.929171. Epub 2014 Jun 20.
Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events.
We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated.
Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent.
Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.
目前胃静脉曲张的最佳内镜治疗仍未标准化。活动性出血的静脉曲张可能会妨碍使用组织黏合剂（N-丁基-2-氰基丙烯酸酯）进行成功的内镜注射治疗。自2006年以来，我们采用标准化的内镜超声（EUS）引导下组织黏合剂注射疗法治疗胃静脉曲张，未发生严重不良事件。
我们展示了一个为期7年的大型单中心队列，对所有胃静脉曲张患者进行标准化的EUS引导下硬化治疗。通过荧光透视控制注射，以立即检测到任何胶水栓塞情况。仅治疗位于胃壁内的穿支静脉。在随访中，我们重复这种治疗直至静脉曲张根除。
绝大多数患者（40例中的36例）在活动性出血期间或24小时内接受治疗。约32.5%的患者在有可见出血时接受治疗。组织黏合剂注射在技术上总是成功的，只有两名患者出现轻微并发症。所有患者的急性出血均停止。约15%（40例中的6例）的患者在较长病程中需要替代抢救治疗。3例患者接受了经颈静脉肝内门体分流术，另外3例接受了原位肝移植。平均60个月的长期生存率良好。
胃静脉曲张的活动性出血可以通过EUS引导下注射组织黏合剂成功治疗，无需洗胃。
