Mansoor-Ul-Haq Muhammad, Latif Abdul, Asad Mansoor, Aziz Memon Farooque
Gastroenterology, Liaquat National Hospital and Medical College, Karachi, PAK.
Gastroenterology, Avicenna Medical College, Lahore, PAK.
Cureus. 2020 Feb 20;12(2):e7062. doi: 10.7759/cureus.7062.
Introduction Gastric varices (GV) are less commonly seen but bleed more severely than esophageal varices (EV). Transjugular intrahepatic portosystemic shunt (TIPS), alcohol injection, and N-butyl-2-cyanoacrylate (NBCA) are generally used for GV bleed management. NBCA is usually injected endoscopically and is known to be quite successful in the treatment of GV bleeding. This study was conducted with the objective of determining the outcomes in patients with GV treated with NBCA. Methods We conducted a retrospective review of medical records and reports of endoscopy performed between March 2015 and June 2018 at a large tertiary care center. Patients of any age and gender having a history of chronic liver disease, those presenting with hematemesis or melena, and those who were found to have GV bleed on endoscopy and treated with NBCA were included. All the endoscopy procedures were undertaken within 24 hours of admission. Informed written consent was obtained from all the patients before the procedure. The outcomes were measured in terms of rate of mortality, hemostasis achieved, duration of stay at the hospital, and requirement of blood transfusion. Results A total of 31 patients met the inclusion criteria; (58.1%) were males and 13 (41.9%) were females. The mean age was 55.23 ±8.77 years; 12.9% were Child-Pugh class-A, 64.5% were class B, and 22.6% were class C. Out of the 31 patients, 27 (87%) patients achieved hemostasis. Moreover, 22 (71%) patients had hospital stay ranging between 5-8 days. The overall mortality rate was 9.7% (3 patients). No complication was reported from NBCA injection. Conclusion The injection of NBCA can provide a safe and effective method for the management of GV bleeding as demonstrated by the results of our study, which showed hemostasis in a majority of the cases after the initial injection with no procedure-related complications, a reduced hospital stay, and a reduced rate of mortality.
引言
胃静脉曲张（GV）不如食管静脉曲张（EV）常见，但出血更为严重。经颈静脉肝内门体分流术（TIPS）、酒精注射和N-丁基-2-氰基丙烯酸酯（NBCA）通常用于治疗GV出血。NBCA通常通过内镜注射，已知在治疗GV出血方面相当成功。本研究旨在确定接受NBCA治疗的GV患者的治疗结果。
方法
我们对2015年3月至2018年6月在一家大型三级医疗中心进行的病历和内镜检查报告进行了回顾性研究。纳入有慢性肝病病史、出现呕血或黑便、在内镜检查中发现GV出血并接受NBCA治疗的任何年龄和性别的患者。所有内镜检查均在入院后24小时内进行。在操作前获得了所有患者的知情书面同意。通过死亡率、止血情况、住院时间和输血需求来衡量治疗结果。
结果
共有31例患者符合纳入标准；18例（58.1%）为男性，13例（41.9%）为女性。平均年龄为55.23±8.77岁；12.9%为Child-Pugh A级，64.5%为B级，22.6%为C级。在31例患者中，27例（87%）实现了止血。此外，22例（71%）患者的住院时间为5至8天。总死亡率为9.7%（3例患者）。未报告NBCA注射的并发症。
结论
我们的研究结果表明，注射NBCA可为治疗GV出血提供一种安全有效的方法，该研究显示，大多数病例在首次注射后实现了止血，无操作相关并发症，住院时间缩短，死亡率降低。
