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World J Gastroenterol. Feb 28, 2007; 13(8): 1247-1251
Published online Feb 28, 2007. doi: 10.3748/wjg.v13.i8.1247
Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding
Khalid Mumtaz, Shahid Majid, Hasnain A Shah, Kashif Hameed, Ashfaq Ahmed, Saeed Hamid, Wasim Jafri
Khalid Mumtaz, Shahid Majid, Hasnain A Shah, Kashif Hameed, Ashfaq Ahmed, Saeed Hamid, Wasim Jafri, Section of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Hasnain A Shah, FRCP, Professor, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan. hasnain.alishah@aku.edu
Telephone: + 92-21-46864676
Received: November 6, 2006
Revised: December 29, 2006
Accepted: February 7, 2007
Published online: February 28, 2007
Abstract

AIM: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV).

METHODS: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophago-gastro-duodenoscopy) and in-hospital mortality were analyzed.

RESULTS: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-I) in 16 (32%), and GOV on greater curvature (GOV-II) in 15 (30%). IGV-I was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P < 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).

CONCLUSION: GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding. In hospital mortality of patients with bleeding GV is 6%.

Keywords: Gastric varices; Portal hypertension; N-butyl cyanoacrylate; Bleeding; Sclerotherapy