Brief Article
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World J Gastroenterol. Mar 21, 2011; 17(11): 1494-1500
Published online Mar 21, 2011. doi: 10.3748/wjg.v17.i11.1494
Long-term result of endoscopic Histoacryl® (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices
Eun Jung Kang, Soung Won Jeong, Jae Young Jang, Joo Young Cho, Sae Hwan Lee, Hyun Gun Kim, Sang Gyune Kim, Young Seok Kim, Young Koog Cheon, Young Deok Cho, Hong Soo Kim, Boo Sung Kim
Eun Jung Kang, Soung Won Jeong, Jae Young Jang, Joo Young Cho, Sae Hwan Lee, Hyun Gun Kim, Sang Gyune Kim, Young Seok Kim, Young Koog Cheon, Young Deok Cho, Hong Soo Kim, Boo Sung Kim, Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul 140-743, South Korea
Author contributions: Kang EJ and Jang JY contributed equally to this work; Jeong SW, Jang JY, Cho JY, Lee SH, Kim SG, Kim YS, Cheon YK, Cho YD, Kim HS and Kim BS provided clinical advice; Kang EJ, Jeong SW and Jang JY performed the research; Kang EJ and Jang JY wrote the paper; Kim HG was responsible for much of the work (statistics) done in response to the critiques.
Correspondence to: Dr. Jae Young Jang, Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul Hospital, 657, Hannam-dong, Yongsan-gu, Seoul 140-743, South Korea. jyjang@hosp.sch.ac.kr
Telephone: +82-2-7099863 Fax: +82-2-7099696
Received: October 22, 2010
Revised: November 12, 2010
Accepted: November 19, 2010
Published online: March 21, 2011
Abstract

AIM: To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl® for treatment of gastric variceal bleeding and prophylaxis.

METHODS: Between January 1994 and March 2010 at SoonChunHyang University Hospital, a total of 127 patients with gastric varices received Histoacryl® injections endoscopically. One hundred patients underwent endoscopic Histoacryl® injections because of variceal bleeding, the other 27 patients received such injections as a prophylactic procedure.

RESULTS: According to Sarin classification, 56 patients were GOV1, 61 patients were GOV2 and 10 patients were IGV. Most of the varices were large (F2 or F3, 111 patients). The average volume of Histoacryl® per each session was 1.7 ± 1.3 cc and mean number of sessions was 1.3 ± 0.6. (1 session-98 patients, 2 sessions-25 patients, ≥ 3 sessions-4 patients). Twenty-seven patients with high risk of bleeding (large or fundal or RCS+ or Child C) received Histoacryl® injection as a primary prophylactic procedure. In these patients, hepatitis B virus was the major etiology of cirrhosis, 25 patients showed GOV1 or 2 (92.6%) and F2 or F3 accounted for 88.9% (n = 24). The rate of initial hemostasis was 98.4% and recurrent bleeding within one year occurred in 18.1% of patients. Successful hemostasis during episodes of rebleeding was achieved in 73.9% of cases. Median survival was 50 mo (95% CI 30.5-69.5). Major complications occurred in 4 patients (3.1%). The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions. None of the 27 subjects who were treated prophylactically experienced treatment-related complications. Cumulative survival rates of the 127 patients at 6 mo, 1, 3, and 5 years were 92.1%, 84.2%, 64.2%, and 45.3%, respectively. The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.

CONCLUSION: Histoacryl® injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which carry high risk of bleeding.

Keywords: Gastric varix; Prophylaxis; Histoacryl® (N-butyl-2-cyanoacrylate); Histoacryl® injection; Treatment of gastric varix