Zeng Yan, Yang Jian, Zhang Jun-Wen
Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
Department of Gastroenterology, Changdu People's Hospital of Xizang, Changdu 854000, Tibet Autonomous Region, China.
World J Gastrointest Endosc. 2024 Jan 16;16(1):29-36. doi: 10.4253/wjge.v16.i1.29.
Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension (LSPH). The hemorrhage is fatal and requires safe and effective interventions.
To evaluate the clinical safety and efficacy of modified endoscopic ultrasound (EUS)-guided selective N-butyl-2-cyanoacrylate (NBC) injections for gastric variceal hemorrhage in LSPH.
A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted. Preoperative EUS evaluations were performed. Enrolled patients were divided into modified and conventional groups according to the NBC injection technique. The final selection of NBC injection technique depended on the patients' preferences and clinical status. The technical and clinical success rates, operation time, NBC doses, perioperative complications, postoperative hospital stay, and recurrent bleeding rates were analyzed, respectively.
A total of 27 patients were enrolled. No statistically significant differences were observed between the two groups regarding baseline characteristics. In comparison to patients in the conventional group, patients in the modified group demonstrated significantly reduced NBC doses (2.0 ± 0.6 mL 3.1 ± 1.0 mL; = 0.004) and increased endoscopic operation time (71.9 ± 11.9 min 22.5 ± 6.7 min; < 0.001). Meanwhile, the two groups had no significant difference in the technical and clinical success rates, perioperative complications, postoperative hospital stay, and recurrent bleeding rates.
Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage, with advantages of reduced injection dose and no radiation risk. Drawbacks were time consumption and technical challenge.
胃静脉曲张出血是左侧门静脉高压（LSPH）的主要表现之一。这种出血是致命的，需要安全有效的干预措施。
评估改良内镜超声（EUS）引导下选择性注射N-丁基-2-氰基丙烯酸酯（NBC）治疗LSPH所致胃静脉曲张出血的临床安全性和疗效。
对LSPH所致胃静脉曲张出血患者进行回顾性观察研究。术前行EUS评估。根据NBC注射技术将入选患者分为改良组和传统组。NBC注射技术的最终选择取决于患者的偏好和临床状况。分别分析技术成功率、临床成功率、手术时间、NBC剂量、围手术期并发症、术后住院时间和再出血率。
共纳入27例患者。两组患者的基线特征无统计学显著差异。与传统组患者相比，改良组患者的NBC剂量显著降低（2.0±0.6 mL对3.1±1.0 mL；P = 0.004），内镜手术时间延长（71.9±11.9分钟对22.5±6.7分钟；P<0.001）。同时，两组在技术成功率、临床成功率、围手术期并发症、术后住院时间和再出血率方面无显著差异。
改良EUS引导下选择性注射NBC治疗LSPH所致胃静脉曲张出血具有安全性和有效性，具有注射剂量降低和无辐射风险的优点。缺点是耗时且技术难度大。
