Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2015; 7(4): 411-416
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.411
N-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices
Reda Elwakil, Mohamed Fawzy Montasser, Sara M Abdelhakam, Wesam A Ibrahim
Reda Elwakil, Mohamed Fawzy Montasser, Sara M Abdelhakam, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Wesam A Ibrahim, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Author contributions: Elwakil R and Montasser MF designed the research; Elwakil R performed the research; Elwakil R, Montasser MF and Abdelhakam SM contributed analytic tools; Elwakil R, Montasser MF, Abdelhakam SM and Ibrahim WA analyzed the data; Elwakil R, Abdelhakam SM and Ibrahim WA wrote the paper.
Ethics approval: This study was reviewed and approved by Research Ethics Committee of Faculty of Medicine, Ain Shams University.
Clinical trial registration: This study is registered at [https://clinicaltrials.gov/ct2/show/study/NCT02330731?show_desc=Y#desc]. The registration identification number is [NCT02330731 Unique Protocol ID: 482].
Informed consent: All of the participants in the study provided written informed consent prior to study enrollment.
Conflict-of-interest: None of the authors have any conflicts of interests and no financial disclosure.
Data sharing: The technical appendix, statistical code, and dataset are available from the corresponding author at saratropical@yahoo.com. The participants gave informed consent for the data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara M Abdelhakam, MD, Assistant Professor, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Khalifa El-Maamon St, Abbassia, Cairo 11341, Egypt. saratropical@yahoo.com
Telephone: +20-2-24820716 Fax: +20-2-22598751
Received: November 5, 2014
Peer-review started: November 5, 2014
First decision: December 25, 2014
Revised: January 6, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: April 16, 2015
Processing time: 165 Days and 11.5 Hours
Abstract

AIM: To compare n-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and a mixture of 72% chromated glycerin with hypertonic glucose solution in management of gastric varices.

METHODS: Ninety patients with gastric varices presented to Endoscopy Unit of Ain Shams University Hospital were included. They were randomly allocated into three groups; each group included 30 patients treated with intravariceal sclerosant injections in biweekly sessions till complete obturation of gastric varices; Group I (n-butyl-2-cyanoacrylate; Histoacryl®), Group II (iso-amyl-2-cyanoacrylate; Amcrylate®) and Group III (mixture of 72% chromated glycerin; Scleremo® with glucose solution 25%). All the procedures were performed electively without active bleeding. Recruited patients were followed up for 3 mo.

RESULTS: 26% of Scleremo group had bleeding during puncture vs 3.3% in each of the other two groups with significant difference, (P < 0.05). None of Scleremo group had needle obstruction vs 13.3% in each of the other two groups with no significant difference, (P > 0.05). Rebleeding occurred in 13.3% of Histoacryl and Amcrylate groups vs 0% in Scleremo group with no significant difference. The in hospital mortality was 6.6% in both Histoacryl and Amcrylate groups, while it was 0% in Scleremo group with no significant difference. In the first and second sessions, the amount of Scleremo needed for obturation was significantly high, while the amount of Histoacryl was significantly low. Scleremo was the less costly of the two treatments.

CONCLUSION: All used sclerosant substances showed efficacy and success in management of gastric varices with no significant differences except in total amount, cost and bleeding during puncture.

Keywords: Gastric varices; N-butyl-2-cyanoacrylate; Iso-amyl-2-cyanoacrylate; Hypertonic glucose solution; 72% chromated glycerin

Core tip: We compared n-butyl-2-cyanoacrylate (Histoacryl®), iso-amyl-2-cyanoacrylate (Amcrylate®) and a mixture of 72% chromated glycerin (Scleremo®) with hypertonic glucose solution (25%) in management of gastric varices. The study included 90 patients who were randomly allocated into three groups, and each group included 30 patients treated with sclerosant injections in biweekly sessions till complete obturation: Group I (Histoacryl®), Group II (Amcrylate®) and Group III (Scleremo® with Glucose 25%). Patients were followed up for 3 mo. We concluded that all used sclerosants showed efficacy and success in management of gastric varices, without significant differences, except in total amount, cost and bleeding during puncture.