Sharma Barjesh C, Varakanahalli Shivakumar, Singh Jatinder P, Srivastava Siddharth
Department of Gastroenterology, GB Pant Hospital, JL Nehru Marg, New Delhi 110002, India.
J Clin Exp Hepatol. 2017 Jun;7(2):97-101. doi: 10.1016/j.jceh.2016.09.002. Epub 2017 Feb 22.
Gastric varices (GV) are found in patients with portal hypertension. Incidence of bleeding from GV is relatively low, but is severe, and associated with higher mortality.
To compare the types of GV in cirrhosis vs. extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic -butyl-2-cyanoacrylate (NBC, glue) injection.
Four hundred and fifty-four patients undergone glue injection of GV for primary prophylaxis or control of bleeding for first episode of bleeding from GV between August 2010 and August 2015 were analyzed.
Of 454 patients, 64% ( = 292) were cirrhotics and 36% ( = 162) had EHPVO. Types of GV were GOV1 in 16.4% ( = 48) of cirrhotics vs. 7.4% ( = 12) of EHPVO, GOV2 in 76.7% ( = 224) of cirrhotics vs. 53.1% ( = 86) of EHPVO, Isolated gastric Varices (IGV1) in 39.5% ( = 64) of patients with EHPVO vs. 6.8% ( = 20) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 2.89 ± 1.59 ml over a median of 1 session (range: 1-7). The total volume of glue required was lower in cirrhotics (2.44 ± 1.17 ml vs. 3.69 ± 1.91 ml, < 0.05) than in EHPVO patients. One hundred and seventeen (40.1%) of cirrhotics required >1 sessions of glue injection as compared to 102 (63%) of EHPVO patients. Over mean follow up of 14.7 ± 6.46 months, rebleeding (10% vs. 13%) was similar in patients with cirrhosis and EHPVO and mortality (15.4% vs. 2.5%) was higher in cirrhotics than EHPVO.
In patients with bleeding from GV, GOV2 are more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for GV obturation.
胃静脉曲张（GV）见于门静脉高压患者。GV出血的发生率相对较低，但病情严重，且死亡率较高。
比较肝硬化与肝外门静脉阻塞（EHPVO）患者GV的类型以及内镜下注射氰基丙烯酸正丁酯（NBC，胶水）的结果。
分析了2010年8月至2015年8月期间454例行GV胶水注射以进行一级预防或控制首次GV出血发作的患者。
454例患者中，64%（n = 292）为肝硬化患者，36%（n = 162）患有EHPVO。GV类型方面，肝硬化患者中16.4%（n = 48）为GOV1型，而EHPVO患者中为7.4%（n = 12）；肝硬化患者中76.7%（n = 224）为GOV2型，EHPVO患者中为53.1%（n = 86）；EHPVO患者中39.5%（n = 64）为孤立性胃静脉曲张（IGV1）型，肝硬化患者中为6.8%（n = 20）。患者接受NBC注射治疗。胶水注射的平均量为2.89±1.59 ml，中位注射次数为1次（范围：1 - 7次）。肝硬化患者所需胶水总量低于EHPVO患者（2.44±1.17 ml对3.69±1.91 ml，P < 0.05）。117例（40.1%）肝硬化患者需要>1次胶水注射，而EHPVO患者为102例（63%）。平均随访14.7±6.46个月，肝硬化和EHPVO患者的再出血率相似（10%对13%），但肝硬化患者的死亡率（15.4%对2.5%）高于EHPVO患者。
在GV出血患者中，GOV2型在肝硬化患者中更常见，IGV1型在EHPVO患者中更常见。EHPVO患者封堵GV所需胶水总量更高且注射次数更多。
