Abstract
Aim: To compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding gastric varices (GVH).
Methods: Sixty patients with bleeding gastric varices were included in the study. Patients were subjected after randomization to either EVL of gastric varices (group I: 30 patients) or cyanoacrylate injection (group II: 30 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients.The primary endpoint was initial hemostasis which was defined as cessation of bleeding for more than 72 hours.
Results: Control of active variceal bleeding was achieved in 20 patients (80%) in group I and all the patients (100%) in group II. The difference was statistically significant (p =0.03). Re-bleeding was seen in 4 patients (13.3%) in group I and 1 patient in group II (3.3%). Gastric varix obliteration was achieved after one session in 33.3% of patients in group I and 60% of patients in group II, however after 2 sessions it was achieved in 66.7% in group I and 96.7% in group II. After 3 sessions variceal obliteration was achieved in 100% in group I. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I.
Conclusion: Cyanoacrylate glue injection is superior to EVL for achieving hemostasis and preventing recurrence of gastric variceal rebleeding but has no advantage over GVL for mortality and complications.