ABSTRACT
Background: Isolated gastric varices [IGV] are one of the major causes of upper gastro intestinal bleeding in cases with liver cirrhosis. They are difficult to manage and N butryl cyanoacrylate is one of the options
Objective: To determine the efficacy of N butryl cyanoacrylate in cases with isolated gastric varices due to liver cirrhosis
Methodology: This cross-sectional study was conducted at Endoscopy unit of Hamza Medicare Hospital, Rahim Yar Khan from 1st January 2015 to 31 th July 2016. The cases presenting with upper GI bleedy and history of liver cirrhosis [documented by presence of jaundice, ascites, hepatic encephalopathy, deranged LFTs, i.e. serum bilirubin, PT, albumin] irrespective of etiology and the child pugh class were included. The endoscopy was done by Olympus GIF-XQ140 and the site of bleeding varices were documented. The cases of isolated gastric varices of any type or severity were considered. Then glue comprising N butryl cyanoacrylate with lipoid solution in a ratio of 5:8 was injected into the varices in a dose of 2.5 to 5 cc and were then followed for next 5 days for any re bleeding episode and control of homeostasis. The cases, in which no such event was noted, were labeled as with positive efficacy. The data was entered and analyzed by using SPSS version 21
Results: In this study out of total 54 cases of IGV, there were 34 [62.96%] males and 20 [37%] females. The mean age was 58.50 +/- 15.54 years. There were 47 cases with hepatitis C and 7 has hepatitis B. Efficacy was seen in 52 [96.30%] out of 54 cases. Thirty-three out of 34 males and 19 out of 20 females has shown efficacy with p value of 0.80. The efficacy was better seen with age group of 15 to 35 years with cure in 5 [100%] out of 5 cases as compared to lower rate in others with p= 0.27. The cases with Child pugh class C contained the both failure cases with significant p= 0.04. There were one case each with hepatitis B and C with failure with p= 0.39
Conclusion: N butryl cyanoacrylate has a high efficacy rate in shortterm relief for bleeding and Child pugh class C is significantly associated with lower success rate
ABSTRACT
Background: Liver cirrhosis, associated with upper gastrointestinal [GI] bleed, is one of the leading cause of morbidity and mortality. Esophageal and isolated gastric varices, both are common but the later is the more difficult to treat
Objective: to determine the frequency of isolated gastric varices in cases with liver cirrhosis presenting with upper gastrointestinal bleeding
Methodology: This cross sectional study was conducted at Hamza Medicare Hospital, Rahim Yar Khan from 1 January 2015 to 31 July 2016. The cases with upper GI bleeding due to liver cirrhosis [assessed by presence of ascites, splenomegaly and deranged liver functions like LFTs, PT] were included in this study. Sociodemographic data was collected like age, gender and other data like type of viral hepatitis and other examination to label for their child pugh class. The cases then underwent upper GI endoscopy with Olympus GIF-XQ140 and were assessed for presence of ulcers or varices from esophagus to stomach. The cases with varices of any size or type only in the gastric area were labeled as isolated gastric varices [IGV]. The data was entered and analyzed by SPSS version 21
Results: In this study there were total 662 cases of liver cirrhosis out of which 180 [27.19%] were females and 482 [72.81%] males. The mean age was 58.50+/- 15.51years. There were 495 [74.77%] cases with hepatitis C and 167 [25.23%] with hepatitis B virus. Isolated gastric varices. [IGV] were seen in 54 [8.17%] cases. All the cases were in GV1 class and all has size of more than 10 mm. IGV were seen in 34 [7.05%] males as compared to 20 [11.11%] females [p value= 0.53]. There was no significant association of GV with any age group with p= 0.17. There was significant association of IGV with child pugh class C [p=0.03]. There was no significant association with type of hepatitis with IGV [p=0.21]
Conclusion; Isolated gastric varices are common entity and every twelfth case of liver cirrhosis develops this. Child pugh class C is significantly associated with isolated gastric avarices