Daneti Dharanesh, Senthamizhselvan Kuppusamy, Chandra Mamidala R V, Mohan Pazhanivel, Kate Vikram
Department of Medical Gastroenterology, JIPMER, Puducherry, India.
Department of Surgery, JIPMER, Puducherry, India.
J Clin Exp Hepatol. 2024 May-Jun;14(3):101315. doi: 10.1016/j.jceh.2023.101315. Epub 2023 Dec 21.
Gastric variceal bleeding (GVB), compared to esophageal varices, is rare but often massive and associated with high mortality. Endoscopic cyanoacrylate glue injection (ECGI) is the first-line treatment for GVB. Hence, we conducted this study to assess the clinical outcomes and the determinants of ECGI for gastric variceal bleeding.
This was a prospective observational study of patients with ECGI for GVB between June 2019 and February 2023. The demographic characteristics, etiology and severity of cirrhosis, size, type of gastric varices, volume of cyanoacrylate used, number of sessions required, technical success, rebleeding rate, and survival at three months were studied.
A total of 135 patients underwent ECGI for GVB. Their mean (SD) age was 44.9 (13.6) years, with a male preponderance (n = 23, 68.1 %). Eighty-two patients (60.7 %) had cirrhosis. Their mean model for end-stage liver disease (MELD) score was 14.3 (7.3). Gastric varices were gastroesophageal varices (GOV)1 in 42 (31.1 %), GOV2 in 73 (54.1 %), and isolated gastric varices (IGV)1 in 20 (14.8 %) patients. Varices were large in 35 (25.9 %) and had F1 morphology in 89 (65.9 %) patients. The success rate of initial hemostasis was 98.5 %. The median sessions required were 1 (1-2), and the median volume of cyanoacrylate per session was 2 (1-2) ml. The procedure was associated with minor complications like transient abdominal pain in 11 (8.1 %) and fever in 2 (2.7 %) patients. Rebleeding was observed in 23 (17 %) patients. GOV2, F1 morphology, and a high MELD score were significantly associated with rebleeding. Five (3.7 %) patients died during the study; 2 (1.5 %) were due to failure to control bleeding.
In conclusion, our study demonstrated ECGI to be very safe and effective for GVB. The technical success was high and could be achieved in fewer sessions with a smaller volume of cyanoacrylate during each session.
与食管静脉曲张相比，胃静脉曲张出血（GVB）较为少见，但通常出血量较大且死亡率高。内镜下注射氰基丙烯酸酯胶（ECGI）是GVB的一线治疗方法。因此，我们开展了本研究以评估ECGI治疗GVB的临床疗效及相关决定因素。
这是一项对2019年6月至2023年2月期间接受ECGI治疗GVB患者的前瞻性观察研究。研究了患者的人口统计学特征、肝硬化的病因及严重程度、胃静脉曲张的大小、类型、所用氰基丙烯酸酯的量、所需治疗次数、技术成功率、再出血率以及三个月时的生存率。
共有135例患者接受了ECGI治疗GVB。他们的平均（标准差）年龄为44.9（13.6）岁，男性占多数（n = 23，68.1%）。82例患者（60.7%）患有肝硬化。他们的平均终末期肝病模型（MELD）评分为14.3（7.3）。42例（31.1%）患者的胃静脉曲张为胃食管静脉曲张（GOV）1型，73例（54.1%）为GOV2型，20例（14.8%）为孤立性胃静脉曲张（IGV）1型。35例（25.9%）静脉曲张较大，89例（65.9%）患者的静脉曲张形态为F1型。初始止血成功率为98.5%。所需治疗次数的中位数为1（1 - 2）次，每次治疗氰基丙烯酸酯的中位数用量为2（1 - 2）ml。该操作与一些轻微并发症相关，如11例（8.1%）患者出现短暂腹痛和2例（2.7%）患者发热。23例（17%）患者出现再出血。GOV2型、F1型形态和高MELD评分与再出血显著相关。5例（3.7%）患者在研究期间死亡；2例（1.5%）死于出血未能控制。
总之，我们的研究表明ECGI治疗GVB非常安全有效。技术成功率高，每次治疗使用较少体积的氰基丙烯酸酯且所需治疗次数较少即可实现。
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