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Article Type

Original Study

Abstract

Context Gastric variceal (GV) bleeding is a serious complication in patients with cirrhosis, as it is usually severe with high rate of mortality and rebleeding. Aim The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with isoamyl-2-cyanoacrylate (Amcrylate) in patients with cirrhosis with GV (gastroesophageal varices type 2 and isolated gastric varices type 1) bleeding. Patients and methods We prospectively studied 34 patients with cirrhosis with bleeding GV who were treated with intravariceal injection of isoamyl-2-cyanoacrylate (Amcrylate). Statistical method Data were expressed as the mean ± SD or as number (%) for numerical variables. Results After a mean dose of 1.86 ± 0.49 ml (range: 1–3 ml) of isoamyl-2-cyanoacrylate was injected in each patient, hemostasis was achieved initially in 100% of patients and complete obliteration of GV in 100% of patients. Treatment-related complications occurred in 26.5% of patients (9/34), but all complications were transient and mild. Complications included ulceration at site of injection (8.8%), fever (2.9%), abdominal pain (5.8%), chest pain (5.8%), and transient dysphagia (2.9%). Only one (2.9%) patient died closed to the cyanoacrylate treatment during hospitalization owing to hepatic encephalopathy and hepatorenal syndrome type I. During mean follow-up of 11.9 + 5.2 months (range: 2 weeks–21 months), rebleeding occurred in 8.8% of our patients. Conclusion This study has demonstrated the efficacy and safety of endoscopic treatment of bleeding GV using isoamyl-2-cyanoacrylate injection with initial hemostasis and complete obliteration of GV with no serious complications and low risk of rebleeding and bleeding-related death.

Keywords

Cyanoacrylates, endoscopic variceal obliteration, endoscopy, gastric varices, hemostasis, isoamyl-2-cyanoacrylate, liver cirrhosis

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