A team of researchers from Taiwan compared the efficacy and complications of cyanoacrylate injection and banding ligation. Both have already been proven to be effective in the management of bleeding gastric varices.
Patients with cirrhosis and a history of gastric variceal bleeding were randomized to injection (n = 31) or banding (n = 29) groups. Butyl cyanoacrylate or a pneumatic-driven ligator were applied, respectively, to the two groups.
Treatment was repeated regularly until obliteration of the gastric varices.
It was found active bleeding occurred in 15 patients in the injection group and 11 patients in the banding group
The initial hemostatic rate, defined as no bleeding for 72 hours after treatment, was 87% in the injection group and 45% in the banding group
|No bleeding after 72 hours of treatment:|
Injection group: 87%
Banding group: 45%
The number of sessions required to achieve variceal obliteration and obliteration were similar in both the groups.
However, re-bleeding rates were significantly higher in the banding group (54%) than in the injection group (31%).
Treatment-induced ulcer bleeding and the amount of blood transfusions required were also found to be higher in the banding group.
There were 9 patient deaths in the injection group, compared to 14 in the banding group.
Dr Gin Ho Lo of the National Yang-Ming University Taiwan, concluded on behalf of colleagues,
"Endoscopic injection therapy using cyanoacrylate proved more effective and safer than band ligation in the management of bleeding gastric varices."