Progression of gastric variceal hemorrhage is poorer than esophageal variceal bleeding.
However, data on its optimal treatment are limited.
Dr Ming-Chih Hou and colleagues from Taiwan designed a prospective study comparing the efficacy of endoscopic band ligation and endoscopic N-butyl-2-cyanoacrylate injection.
The investigative team included liver patients with cirrhosis with or without concomitant hepatocellular carcinoma.
The team also assessed patients presenting with acute gastric variceal hemorrhage.
The patients were randomized into 2 treatment groups.
There were 48 patients in Group 1 who received endoscopic band ligation, and another 49 patients in Group 2 receiving N-butyl-2-cyanoacrylate injections.
The investigators found that both treatments were equally successful in controlling active bleeding.
The team noted that more patients who underwent endoscopic band ligation had rebleeding.
|Rebleeding with endoscopic band ligation occurred in 2% vs 27% with njections|
The 2-year and 3-year cumulative rate of rebleeding were 63% and 72% for endoscopic band ligation, and 27% for both periods with the injection.
The investigative team observed that rebleeding risk of endoscopic band ligation was sustained throughout the entire follow-up period.
Multivariate Cox regression showed concomitance with hepatocellular carcinoma, and the treatment method as independent predictors of rebleeding.
There was no difference in survival between the 2 groups.
The investigators noted that severe complications attributable to these 2 treatments were rare.
Dr Hou's team commented, “The efficacy of endoscopic band ligation to control active gastric variceal hemorrhage appears not different to N-butyl-2-cyanoacrylate injection, but the injection is associated with a lower rebleeding rate.”