N-butyl-2-cyanoacrylate (Histoacryl) plus sclerotherapy versus sclerotherapy alone in the treatment of bleeding esophageal varices: a randomized prospective study.

BACKGROUND AND STUDY AIMS

N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding. The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates.

PATIENTS AND METHODS

One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polidocanol, and 59 patients (Group B) were treated with conventional sclerotherapy with polidocanol alone. Histoacryl was injected intravariceally during the first session in the Group A patients.

RESULTS

A significantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Group A: 2 of 20, Group B: 8 of 18, p < 0.05). The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B: 9 of 18, p < 0.05).

CONCLUSIONS

The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophageal bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management.