Retrospective Study
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World J Gastroenterol. Dec 7, 2014; 20(45): 17127-17131
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17127
Proton pump inhibitor administration delays rebleeding after endoscopic gastric variceal obturation
Won Seok Jang, Hyun Phil Shin, Joung Il Lee, Kwang Ro Joo, Jae Myung Cha, Jung Won Jeon, Jun Uk Lim
Won Seok Jang, Hyun Phil Shin, Joung Il Lee, Kwang Ro Joo, Jae Myung Cha, Jung Won Jeon, Jun Uk Lim, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul 130-701, South Korea
Author contributions: Jang WS and Shin HP designed the study and wrote the manuscript; Lee JI contributed to the design and editing of the study; Joo KR and Cha JM provided analytical tools; Jeon JW and Lim JU collected the study material and edited the manuscript; all authors approved the final manuscript.
Correspondence to: Hyun Phil Shin, MD, PhD, Department of Internal Medicine, College of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 130-701, South Korea. megadoctor@medimail.co.kr
Telephone: +82-2-4408149 Fax: +82-2-4408150
Received: February 13, 2014
Revised: May 24, 2014
Accepted: July 24, 2014
Published online: December 7, 2014
Abstract

AIM: To clarify the efficacy of proton pump inhibitors (PPIs) after endoscopic variceal obturation (EVO) with N-butyl-2-cyanoacrylate.

METHODS: A retrospective study was performed on 16 liver cirrhosis patients with gastric variceal bleeding that received EVO with injections of N-butyl-2-cyanoacrylate at a single center (Kyung Hee University Hospital at Gangdong) from January 2008 to December 2012. Medical records including patient characteristics and endoscopic findings were reviewed. Treatment results, liver function, serum biochemistry and cirrhosis etiology were compared between patients receiving PPIs and those that did not. Furthermore, the rebleeding interval was compared between patients that received PPI treatment after EVO and those who did not.

RESULTS: The patient group included nine males and seven females with a mean age of 61.8 ± 11.7 years. Following the EVO procedure, eight of the 12 patients that received PPIs and three of the four non-PPI patients experienced rebleeding. There were no differences between the groups in serum biochemistry or patient characteristics. The rebleeding rate was not significantly different between the groups, however, patients receiving PPIs had a significantly longer rebleeding interval compared to non-PPI patients (22.2 ± 11.2 mo vs 8.5 ± 5.5 mo; P = 0.008). The duration of PPI use was not related to the rebleeding interval. A total of six patients, who had ulcers at the injection site, exhibited a shorter rebleeding interval (16.8 ± 5.9 mo) than patients without ulcers (19.9 ± 3.2 mo), though this difference was not statistically significant.

CONCLUSION: PPI therapy can extend the rebleeding interval, and should therefore be considered after EVO treatment for gastric varices.

Keywords: Cirrhosis, Endoscopic variceal obturation, N-butyl-2-cyanoacrylate, Proton pump inhibitor, Rebleeding interval

Core tip: Endoscopic variceal obturation (EVO) with N-butyl-2 cyanoacrylate is a first-line treatment for gastric variceal bleeding. Although proton pump inhibitors (PPIs) are administered to decrease the adverse effects of endoscopic variceal ligation, their effects following EVO for gastric varices are unclear. In this study, patients who received PPI therapy had a longer rebleeding interval after EVO with N-butyl-2-cyanoacrylate, suggesting it has beneficial effects for gastric variceal bleeding.