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A single histoacryl injection may be sufficient for bleeding gastric varices

A study published in the latest European Journal of Gastroenterology & Hepatology evaluates the efficacy and long-term outcomes of patients treated with a single session of histoacryl sclerotherapy for active gastric variceal bleeding.

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Gastric variceal bleeding is one of the most feared complications of portal hypertension and hence merits investigation for its optimal therapy.

Dr Ali Khawaja and colleagues evaluated the efficacy and long-term outcomes of patients treated with a single session of histoacryl sclerotherapy for active gastric variceal bleeding.

The medical records of patients who presented with active gastric variceal bleeding between 1998 and 2011 in a tertiary care setting were evaluated retrospectively and the eventual outcomes were assessed at least 1 year after the index bleed.

The research team evluated 97 patients.

The mean age of the patients was 51 years, of which 62% were men.

Hepatitis C was the most common etiology, found in 65% of patients.

Re-bleeding was seen in 27% of patients during the 1-year follow-up
European Journal Gastroenterology & Hepatology

The research team noted that the majority of the patients were classified as Child–Pugh grade B and C.

The team observed that a total of 41% of patients were IGV1, 36% of patients were GOV 2, 21% of patients were GOV 1, and 2% of patients were IGV2.

A single session of histoacryl was successful in controlling bleeding in 86% of patients.

The team reported that 7% patients died during the hospital stay.

The researchers observed rebleeding in 27% of patients during the 1-year follow-up, of whom 50% were managed successfully with repeated histoacryl injection.

The overall mortality rate at 6 weeks, 6 months, and 1 year was 14%, 20%, and 27% patients, respectively.

The team noted that Child–Pugh classification was a significant prognostic factor of survival.

Dr Khawaja's team concludes, "A single session of histoacryl sclerotherapy is effective in the majority of patients with active gastric variceal bleeding."

"Rebleeding was observed in one-fourth of patients, half of whom were controlled successfully by repeated histoacryl sclerotherapy."

Eur J Gastroenterol Hepatol 2014: 26(6): 661-667
23 May 2014

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