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Background and ObjectivesGastric variceal hemorrhage treatment remains a difficult issue for clinicians. There is controversy regarding whether first-line treatment should be endoscopic therapy with cyanoacrylate glue or placement of a transjugular intrahepatic portosystemic shunt (TIPS). We compared these methods on the basis of rebleeding, survival, and complications. Design, Setting, Patients, and InterventionsThis was a retrospective cohort analysis of cirrhotic patients with gastric variceal hemorrhage treated with endoscopic cyanoacrylate therapy or TIPS placement at a single U.S. center from 1997 to 2007. The groups were compared for rebleeding at 72 hours, 3 months, and 1 year; survival rates at 3 months and 1 year; and acute and extended complications and morbidity. Main Outcome Measurements and ResultsA total of 105 patients were included. There were no significant pretreatment differences between the 2 groups in age, sex, MELD (Model for End-Stage Liver Disease) score at the time of admission, or cause of liver disease. There were no significant differences in rebleeding at 72 hours, 3 months, and 1 year; survival at 3 months and 1 year; and aggregate long-term survival or acute complications. However, the TIPS group had a higher rate of long-term morbidity requiring hospitalization (41% with a TIPS and 1.6% in the cyanoacrylate arm, P < .0001). LimitationsRetrospective and uncontrolled samples. ConclusionIn patients with similar characteristics, cyanoacrylate therapy performed as well as a TIPS in controlling and preventing gastric variceal hemorrhage with no significant differences in survival. Patients receiving cyanoacrylate therapy experienced significantly less long-term morbidity related to therapy than patients who received a TIPS. Cyanoacrylate therapy appears to be safe and effective and compares favorably with TIPS therapy. Charlottesville, Virginia, USA Abbreviation: TIPS, transjugular intrahepatic portosystemic shunt Current affiliations: Division of Gastroenterology and Hepatology, Digestive Health Center of Excellence. University of Virginia Health System, Charlottesville, Virginia, USA
DISCLOSURE: All authors disclosed no financial relationship relevant to this publication. See CME section; p. 976. PII: S0016-5107(09)01702-7 doi:10.1016/j.gie.2009.03.1169 © 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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ABSTRACT
Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis