Endoscopic sclerotherapy with n-butyl-2-cyanoacrylate versus ethanolamine oleate in treatment of bleeding gastric varices

الملخص EN

Introduction: gastric varietal bleeding is associated with significant morbidity and mortality in patients with portal hypertension.

Gastric varietal injection of N-butyl-2-cyanoacrylate has been shown to be effective however; rare serious side effects have been reported as pulmonary embolism and portal vein thrombosis.

Also, the optimal treatment of bleeding gastro esophageal varies is not yet fully determined and whether to use ethanolamine locate or N-butyl-2-cyanoacrylate for sclerotherapy is not yet clear.

Aim of the work : to compare between N-butyl-2-cyanoacrylate (NBC) and ethanolamine locate (EAO) injection in patients with bleeding gastric varies.

Patients and Methods: this study included 157 patients with bleeding gastric varies underwent sclerotherapy in Assuit University Hospital Endoscopy Unit.

Fifty two patients with bleeding isolated gastric varies (IGV) underwent sclerotherapy with a mean of 2 mL NBC.

One hundred and five patients with bleeding gastro-esophageal varies (GOV) were randomly divided into 2 groups.

The first group included 36 patients were subjected to endoscopic varietal observation using NBC.

The second group included 69 patients were subjected to endoscopic sclerotherapy using EAO.

Outcome parameters were primary hemostasis (bleeding control within the first 48 hs.), and recurrent bleeding (after 48 hs.

of esophagi-gastro-duodenoscopy).

All those patients were followed up for one week after sclerotherapy to detect rebreeding or any intervention related complications.

Results : primary hemostasis was significantly higher in patients treated with NBC than those treated with EAO (96.6 % vs.

82.6 %; p < 0.005).

Re-bleeding within one week after initial sclerotherapy was significantly lower in patients treated with NBC than those treated with EAO (5.9 % vs.

19.3 %; p < 0.05).

In patients with gastro esophageal varies type 1, there was no statistically significant difference between NBC and EAO sclerotherapy regarding primary hemostasis (100 % vs.

91.5 %; p > 0.05) and rebreeding (no cases vs.

9.3 % p > 0.05).

In patients with gastro esophageal varies type 2, there was high statistically significant difference between NBC and EAO sclerotherapy regarding primary hemostasis (100 % vs.

63.3 %; p < 0.005) and rebreeding (no cases vs.

50 % p < 0.005).

No significant difference was present between NBC and EAO sclerotherapy regarding the occurrence of intervention related complications.

Secondary hemostasis was achieved with NBC sclerotherapy in 100% of cases presented with failure of primary hemostasis or rebreeding.

No mortality cases reported during the first week of follow up in both groups.

Conclusion : N-butyl-2-cyanoacrylate is safe and statistically significantly more effective than ethanolamine locate in controlling GV bleeding.

Ethanolamine locate sclerotherapy still hayed a role in treatment of bleeding gastro esophageal varies type one only.