EFFECTIVENESS OF HISTOACRYL INJECTION IN THE MANAGEMENT OF FUNDAL VARICEAL BLEEDING
DOI:
https://doi.org/10.70520/kjms.v19i1.794Keywords:
Upper gastrointestinal bleeding, fundal varices, Histoacryl injectionAbstract
Objectives: To assess the effectiveness of Histoacryl glue in the treatment of haemorrhage due to varices in the gastric fundus.
Materials and Methods: This cross-sectional research was carried out at the Department of Gastroenterology of Hayatabad Medical Complex, Peshawar. All those with haemorrhage from varices in the fundus were included in the study after application of exclusion criteria. A comprehensive gastroscopy was conducted after patients were stabilized and the source of haemorrhage from varices in the gastric fundus was confirmed, after which histoacryl glue was administered into these varices via a needle, and hemostasis achievement was observed. All data were analyzed using SPSS 22, and descriptive statistics were computed for the study variables.
Results: A total of one hundred and forty-nine participants having haemorrhage from varices in the gastric fundus were examined, out of which 59.73% (n=89) were male, and 40.26% (n=60) were females. The most common age group of patients was 40 – 50 years, having 42.28% (n=63) of patients. The majority (86.57%) of the patients had OGV-II type of varices, hence being the commonest. The most common reason for having varices in the gastric fundus was cirrhosis (73.82%). Hemorrhage was controlled successfully in 98.65% of patients after one session of histoacryl application.
Conclusion: Endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) achieved immediate hemostasis after a single session in our study, indicating that Histoacryl is a highly effective first-line therapy for acute bleeding from fundal varices. Further prospective studies with longer follow-up are warranted to assess rebleeding rates and long-term outcomes.
References
1. Qiao W, Ren Y, Bai Y, Liu S, Zhang Q, Zhi F. Cyanoacrylate injection versus band ligation in the endoscopic management of acute gastric variceal bleeding: meta-analysis of randomized, controlled studies based on the PRISMA statement. Medicine (Baltimore). 2015;94(41):e1725.
2. Kim MY, Um SH, Baik SK, et al. Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data. Clin Mol Hepatol. 2013;19(1):36.
3. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long?term follow?up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343-1349.
4. Seewald S, Sriram PVJ, Naga M, et al. Cyanoacrylate glue in gastric variceal bleeding. Endoscopy. 2002;34(11):926-932.
5. Franchis D. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762-768.
6. Soehendra N, Nam VC, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986;18(01):25-26.
7. Gotlib JP, Zimmermann P. Une nouvelle technique de traitement endoscopique des varices oesophagiennes: l’obliteration. Endosc Dig. 1984;7:10-12.
8. Hwang JH, Shergill AK, Acosta RD, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc. 2014;80(2):221-227.
9. Dworzynski K, Pollit V, Kelsey A, Higgins B, Palmer K. Management of acute upper gastrointestinal bleeding: summary of NICE guidance. Bmj. 2012;344.
10. Garcia?Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases the PPC of the AC of G. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922-938.
11. Rengstorff DS, Binmoeller KF. A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans. Gastrointest Endosc. 2004;59(4):553-558.
12. Khawaja A, Sonawalla AA, Somani SF, Abid S. Management of bleeding gastric varices: a single session of histoacryl injection may be sufficient. Eur J Gastroenterol Hepatol. 2014;26(6):661-667.
13. Mumtaz K, Majid S, Shah HA, et al. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding. World J Gastroenterol WJG. 2007;13(8):1247.
14. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33(5):1060-1064.
15. Sarin SK, Jain AK, Jain M, Gupta R. A Randomized Controlled Trial of CyanoacrylateVersusAlcohol Injection in Patients With Isolated Fundic Varices. Off J Am Coll Gastroenterol ACG. 2002;97(4):1010-1015.
16. Tan P, Hou M, Lin H, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N?butyl?2?cyanoacrylate injection versus band ligation. Hepatology. 2006;43(4):690-697.
17. Hou MC, Lin HC, Lee HS, Liao WC, Lee FY, Lee SD. A randomized trial of endoscopic cyanoacrylate injection for acute gastric variceal bleeding: 0.5 mL versus 1.0 mL. Gastrointest Endosc. 2009;70(4):668-675.
18. Oho K, Iwao T, Sumino M, Toyonaga A, Tanikawa K. Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy. 1995;27(05):349-354.
