BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent...BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent than esophageal varices bleeding(EVB),but the former is a more critical illness and has a higher mortality rate.At present,endoscopic variceal histoacryl injection therapy(EVHT)is safe and effective,and it has been recommended by relevant guidelines as the primary method for the treatment of GVB.However,gastric varices after endoscopic treatment still have a high rate of early rebleeding,which is mainly related to complications of its treatment,such as bleeding from drained ulcers,rebleeding of varices etc.Therefore,preventing early postoperative rebleeding is very important to improve the quality of patient survival and outcomes.AIM To assess the efficacy of aluminium phosphate gel(APG)combined with proton pump inhibitor(PPI)in preventing early rebleeding after EVHT in individuals with GVB.METHODS Medical history of 196 individuals with GVB was obtained who were diagnosed using endoscopy and treated with EVHT in Shenzhen People's Hospital from January 2016 to December 2021.Based on the selection criteria,101 patients were sorted into the PPI alone treatment group,and 95 patients were sorted into the PPI combined with the APG treatment group.The incidences of early rebleeding and corresponding complications within 6 wk after treatment were compared between both groups.Statistical methods were performed by two-sample t-test,Wilcoxon rank sum test andχ2 test.RESULTS No major variations were noted between the individuals of the two groups in terms of age,gender,Model for End-Stage Liver Disease score,coagulation function,serum albumin,hemoglobin,type of gastric varices,the dose of tissue glue injection and EV that needed to be treated simultaneously.The early rebleeding rate in PPI+APG group was 3.16%(3/95),which was much lower than that in the PPI group(12.87%,13/101)(P=0.013).Causes of early rebleeding:the incidence of gastric ulcer bleeding in the PPI+APG group was 2.11%(2/95),which was reduced in comparison to that in the PPI group(11.88%,12/101)(P=0.008);the incidence of venous bleeding in PPI+APG group and PPI group was 1.05%(1/95)and 0.99%(1/101),respectively,and there was no significant difference between them(0.999).The early mortality rate was 0 in both groups within 6 wk after the operation,and the low mortality rate was related to the timely hospitalization and active treatment of all patients with rebleeding.The overall incidence of complications in the PPI+APG group was 12.63%(12/95),which was not significantly different from 13.86%(14/101)in the PPI group(P=0.800).of abdominal pain in the PPI+APG group was 3.16%(3/95),which was lower than that in the PPI group(11.88%,12/101)(P=0.022).However,due to aluminum phosphate gel usage,the incidence of constipation in the PPI+APG group was 9.47%(9/95),which was higher than that in the PPI group(1.98%,2/101)(P=0.023),but the health of the patients could be improved by increasing drinking water or oral lactulose.No patients in either group developed spontaneous peritonitis after taking PPI,and none developed hepatic encephalopathy and ectopic embolism within 6 wk of EVHT treatment.CONCLUSION PPI combined with APG can significantly reduce the incidence of early rebleeding and postoperative abdominal pain in cirrhotic patients with GVB after taking EVHT.展开更多
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 Uni...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.展开更多
AIM: To determine the factors associated with clinical outcomes and complications of Histoacryl glue injection for acute gastric variceal hemorrhage. METHODS: Patients who presented to the Siriraj Gastrointestinal E...AIM: To determine the factors associated with clinical outcomes and complications of Histoacryl glue injection for acute gastric variceal hemorrhage. METHODS: Patients who presented to the Siriraj Gastrointestinal Endoscopy Center with active gastric variceal bleeding and were admitted for treatment between April 2008 and October 2011 were selected retrospectively for study inclusion. All bleeding varices were treated by injection of Histoacryl tissue glue (B. Braun Melsungen AG, Germany) through a 21G or 23G catheter primed with lipiodol to prevent premature glue solidification. Data recorded for each patient included demographic and clinical characteristics, endoscopic findings, clinical outcomes in terms of early and late re-bleeding, mortality, and procedure-related complications. Data from admission (baseline) and posttreatment were comparatively analyzed using stepwise logistic regression analysis to determine the correlation between factors and clinical outcomes.RESULTS: A total of 90 patients underwent Histoacryl injection to treat bleeding gastric varices. The mean age was 55.9 ± 13.9 (range: 15-88) years old, and 74.4% of the patients were male. The most common presentations were hematemesis (71.1%), melena (12.2%), and coffee ground emesis (8.9%). Initial hemostasis was experienced in 97.8% of patients, while re-bleeding within 120 h occurred in 10.0%. The presence of ascites was the only factor associated with early and late re-bleeding [odds ratio (OR)=10.67, 95%CI: 1.27-89.52, P=0.03 and OR=4.15, 95%CI: 1.34-12.86, P=0.01, respectively]. Early procedure-related complications developed in 14.4% of patients, and were primarily infections and non-fatal systemic embolization. Late re-bleeding was significantly correlated with early procedure-related complications by univariate analysis (OR=4.01, 95%CI: 1.25-12.87, P=0.04), but no factors were significantly correlated by multivariate analysis. The overall mortality rate was 21.1%, the majority of which were related to infections. The factors showing strong association with higher mortality risk were elevated total bilirubin (OR=16.71, 95%CI: 3.28-85.09, P < 0.01), a large amount of transfused fresh frozen plasma (OR=1.001, 95%CI: 1.000-1.002, P=0.03), and late re-bleeding (OR=10.99, 95%CI: 2.15-56.35, P=0.02).CONCLUSION: Histoacryl injection is a safe and effective hemostatic method for treating gastric variceal hemorrhage. Patients with compromised liver, including ascites, have a higher risk of re-bleeding.展开更多
BACKGROUND Endoscopic approach could effectively manage postoperative anastomotic leakage.Various endoscopic methods have been developed for the treatment of anastomotic leakage.CASE SUMMARY A 53-year-old woman develo...BACKGROUND Endoscopic approach could effectively manage postoperative anastomotic leakage.Various endoscopic methods have been developed for the treatment of anastomotic leakage.CASE SUMMARY A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy.Endoscopic clip closure failed due to strong wall tension;therefore,a fully covered self-expandable esophageal metal stent(fc-SEMS)was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl.However,fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS.Using the previous fluoroscopic image for guidance,a catheter was inserted at the leakage site.The radiocontrast dye was injected and was seen spreading along the sinus tract.Thereafter,histoacryl was injected.Seven days after the last procedure,upper gastrointestinal contrast studies showed no leaks.The patient was subsequently discharged 9 d after histoacryl injection without any complications.CONCLUSION To seal an anastomosis leak after stent application,salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.展开更多
Background:Histoacryl glue(N-butyl-2-cyanoacrylate)has well-established utility in the endoscopic management of gastrointestinal variceal bleeding.The role of Histoacryl glue in non-variceal bleeding is less clear,and...Background:Histoacryl glue(N-butyl-2-cyanoacrylate)has well-established utility in the endoscopic management of gastrointestinal variceal bleeding.The role of Histoacryl glue in non-variceal bleeding is less clear,and there are few articles describing its use in this setting.Methods:Six patients with intractable non-variceal gastrointestinal bleeding were managed using injection of Histoacryl glue.All patients had previously failed conventional endostasis and/or interventional angioembolization and were not suitable for emergency salvage surgery due to serious comorbidities or unacceptable anaesthetic risk.An endoscopic Lipiodol-Histoacryl-Lipiodol sandwich injection technique was used in these patients.The clinical outcomes and complications were evaluated.Results:There were four females and two males with a mean age of 55 years.Bleeding lesions included gastric ulcers(n=2),duodenal ulcers(n=2),duodenal gastrointestinal stromal tumor(GIST)(n=1)and rectal ulcers(n=1).All patients had successful Histoacryl endostasis without the requirement for salvage surgery.There was no treatment-related morbidity and no mortality.Two patients had further bleeding after initial Histoacryl endostasis,which was successfully controlled with further endoscopic Histoacryl injection.Conclusion:Histoacryl endostasis should be included in the treatment algorithm for refractory non-variceal gastrointestinal bleeding.展开更多
基金Supported by Clinical Research and Cultivation Project of Shenzhen People's Hospital,No.SYLCYJ202116.
文摘BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent than esophageal varices bleeding(EVB),but the former is a more critical illness and has a higher mortality rate.At present,endoscopic variceal histoacryl injection therapy(EVHT)is safe and effective,and it has been recommended by relevant guidelines as the primary method for the treatment of GVB.However,gastric varices after endoscopic treatment still have a high rate of early rebleeding,which is mainly related to complications of its treatment,such as bleeding from drained ulcers,rebleeding of varices etc.Therefore,preventing early postoperative rebleeding is very important to improve the quality of patient survival and outcomes.AIM To assess the efficacy of aluminium phosphate gel(APG)combined with proton pump inhibitor(PPI)in preventing early rebleeding after EVHT in individuals with GVB.METHODS Medical history of 196 individuals with GVB was obtained who were diagnosed using endoscopy and treated with EVHT in Shenzhen People's Hospital from January 2016 to December 2021.Based on the selection criteria,101 patients were sorted into the PPI alone treatment group,and 95 patients were sorted into the PPI combined with the APG treatment group.The incidences of early rebleeding and corresponding complications within 6 wk after treatment were compared between both groups.Statistical methods were performed by two-sample t-test,Wilcoxon rank sum test andχ2 test.RESULTS No major variations were noted between the individuals of the two groups in terms of age,gender,Model for End-Stage Liver Disease score,coagulation function,serum albumin,hemoglobin,type of gastric varices,the dose of tissue glue injection and EV that needed to be treated simultaneously.The early rebleeding rate in PPI+APG group was 3.16%(3/95),which was much lower than that in the PPI group(12.87%,13/101)(P=0.013).Causes of early rebleeding:the incidence of gastric ulcer bleeding in the PPI+APG group was 2.11%(2/95),which was reduced in comparison to that in the PPI group(11.88%,12/101)(P=0.008);the incidence of venous bleeding in PPI+APG group and PPI group was 1.05%(1/95)and 0.99%(1/101),respectively,and there was no significant difference between them(0.999).The early mortality rate was 0 in both groups within 6 wk after the operation,and the low mortality rate was related to the timely hospitalization and active treatment of all patients with rebleeding.The overall incidence of complications in the PPI+APG group was 12.63%(12/95),which was not significantly different from 13.86%(14/101)in the PPI group(P=0.800).of abdominal pain in the PPI+APG group was 3.16%(3/95),which was lower than that in the PPI group(11.88%,12/101)(P=0.022).However,due to aluminum phosphate gel usage,the incidence of constipation in the PPI+APG group was 9.47%(9/95),which was higher than that in the PPI group(1.98%,2/101)(P=0.023),but the health of the patients could be improved by increasing drinking water or oral lactulose.No patients in either group developed spontaneous peritonitis after taking PPI,and none developed hepatic encephalopathy and ectopic embolism within 6 wk of EVHT treatment.CONCLUSION PPI combined with APG can significantly reduce the incidence of early rebleeding and postoperative abdominal pain in cirrhotic patients with GVB after taking EVHT.
文摘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.
文摘AIM: To determine the factors associated with clinical outcomes and complications of Histoacryl glue injection for acute gastric variceal hemorrhage. METHODS: Patients who presented to the Siriraj Gastrointestinal Endoscopy Center with active gastric variceal bleeding and were admitted for treatment between April 2008 and October 2011 were selected retrospectively for study inclusion. All bleeding varices were treated by injection of Histoacryl tissue glue (B. Braun Melsungen AG, Germany) through a 21G or 23G catheter primed with lipiodol to prevent premature glue solidification. Data recorded for each patient included demographic and clinical characteristics, endoscopic findings, clinical outcomes in terms of early and late re-bleeding, mortality, and procedure-related complications. Data from admission (baseline) and posttreatment were comparatively analyzed using stepwise logistic regression analysis to determine the correlation between factors and clinical outcomes.RESULTS: A total of 90 patients underwent Histoacryl injection to treat bleeding gastric varices. The mean age was 55.9 ± 13.9 (range: 15-88) years old, and 74.4% of the patients were male. The most common presentations were hematemesis (71.1%), melena (12.2%), and coffee ground emesis (8.9%). Initial hemostasis was experienced in 97.8% of patients, while re-bleeding within 120 h occurred in 10.0%. The presence of ascites was the only factor associated with early and late re-bleeding [odds ratio (OR)=10.67, 95%CI: 1.27-89.52, P=0.03 and OR=4.15, 95%CI: 1.34-12.86, P=0.01, respectively]. Early procedure-related complications developed in 14.4% of patients, and were primarily infections and non-fatal systemic embolization. Late re-bleeding was significantly correlated with early procedure-related complications by univariate analysis (OR=4.01, 95%CI: 1.25-12.87, P=0.04), but no factors were significantly correlated by multivariate analysis. The overall mortality rate was 21.1%, the majority of which were related to infections. The factors showing strong association with higher mortality risk were elevated total bilirubin (OR=16.71, 95%CI: 3.28-85.09, P < 0.01), a large amount of transfused fresh frozen plasma (OR=1.001, 95%CI: 1.000-1.002, P=0.03), and late re-bleeding (OR=10.99, 95%CI: 2.15-56.35, P=0.02).CONCLUSION: Histoacryl injection is a safe and effective hemostatic method for treating gastric variceal hemorrhage. Patients with compromised liver, including ascites, have a higher risk of re-bleeding.
基金2020 Research Fund of the Chungbuk National University.
文摘BACKGROUND Endoscopic approach could effectively manage postoperative anastomotic leakage.Various endoscopic methods have been developed for the treatment of anastomotic leakage.CASE SUMMARY A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy.Endoscopic clip closure failed due to strong wall tension;therefore,a fully covered self-expandable esophageal metal stent(fc-SEMS)was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl.However,fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS.Using the previous fluoroscopic image for guidance,a catheter was inserted at the leakage site.The radiocontrast dye was injected and was seen spreading along the sinus tract.Thereafter,histoacryl was injected.Seven days after the last procedure,upper gastrointestinal contrast studies showed no leaks.The patient was subsequently discharged 9 d after histoacryl injection without any complications.CONCLUSION To seal an anastomosis leak after stent application,salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.
文摘Background:Histoacryl glue(N-butyl-2-cyanoacrylate)has well-established utility in the endoscopic management of gastrointestinal variceal bleeding.The role of Histoacryl glue in non-variceal bleeding is less clear,and there are few articles describing its use in this setting.Methods:Six patients with intractable non-variceal gastrointestinal bleeding were managed using injection of Histoacryl glue.All patients had previously failed conventional endostasis and/or interventional angioembolization and were not suitable for emergency salvage surgery due to serious comorbidities or unacceptable anaesthetic risk.An endoscopic Lipiodol-Histoacryl-Lipiodol sandwich injection technique was used in these patients.The clinical outcomes and complications were evaluated.Results:There were four females and two males with a mean age of 55 years.Bleeding lesions included gastric ulcers(n=2),duodenal ulcers(n=2),duodenal gastrointestinal stromal tumor(GIST)(n=1)and rectal ulcers(n=1).All patients had successful Histoacryl endostasis without the requirement for salvage surgery.There was no treatment-related morbidity and no mortality.Two patients had further bleeding after initial Histoacryl endostasis,which was successfully controlled with further endoscopic Histoacryl injection.Conclusion:Histoacryl endostasis should be included in the treatment algorithm for refractory non-variceal gastrointestinal bleeding.
