Résumé
Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. Gastric variceal injection of N-butyl-2-cyanoacrylate has been shown to be effective however: rare serious side effects have been reported as pulmonary embolism and portal vein thrombosis. Also, the optimal treatment of bleeding gastroesophageal varices is not yet fully determined and whether to use ethanolamine oleale or N-butyI-2-cyanoaCrYlate for sclerotherapy is not yet clear. Aim of the work: To compare between N-butyl-2-cyanoacrylate [NBC] and ethanolamine oleate [EAO] injection in patients with bleeding gastric varices. This study included 157 patients with bleeding gastric varices underwent sclerotherapy in 4ssuit University Hospital Endoscopy Unit. Fifty two patients with bleeding isolated gastric varices [IGV] underwent sclerotherapy with a mean of 2 mL NBC. One hundred and five patients with bleeding gastro-oesophageal varices [GOV] were randomally divided into 2 groups. The first group included 36 patients were subjected to endoscopic variceal obturation using NBC. The second group included 69 patients were subjected to endoscopic sclerotherapy using EAO. Outcome parameters were primary haemostasis [bleeding control within the first 48 hs.], and recurrent bleeding [after 48 hs. of oesophago-gastro-duOdefl0Sc0PY]. All those patients were followed up for one week after sclerotherapy to detect rebleeding or any intervention related complications. Primary haemostasis was significantly higher in patients treated with NBC than those treated with EAO [96.6% vs. 82.6%; p< 0.005]. Re-bleeding within one week after initial sclerotherapy was significantly lower in patients treated with NBC than those treated with EAO [5.9% vs. 19.3%; p< 0.05]. In patients with gastroesophageal varices type 1, there was no statistically significant d4fference between NBC and EAO sclerotherapy regarding primary haemostasis [100% vs. 91.5%, p>0.05] and rebleeding [no cases vs. 9.3% p>0.05]. in patients with gastroesophageal varices type 2, there was high statistically significant difference between NBC and EAO sclerotherapy regarding primary haemostasis [100% vs. 63.3%; p<0.005] and rebleeding [no cases vs. 50% p<0.005]. No significant difference was present between NBC and EAO sclerotherapy regarding the occurrence of intervention related complications. Secondary haemostasis was achieved with NBC sclerotherapy in 100% of cases presented with failure of primary haemostasis or rebleeding. No mortality cases reported during the first week of follow up in both groups. N-butyl2-cyanoaCrYlate is safe and statistically significantly more effective than ethanolamine oleate in controlling GV bleeding. Ethanolamine oleate sclerotherapy still have a role in treatment of bleeding gastroesophageal varices type one only
Résumé
This study assessed platelet activation and possible contribution to the pathogenesis of liver cirrthosis [LC], heaptocellular carcinoma [HCC] and portal vain thrombosis [PVT].forty five patients with LC caused by dual schistosomsis and viral hepatitis infections were enrolled in the study, 15 had LC only, 15 were complicated with HCC, and 15 were complicated with PVT, addition to healthy controls. Platelet morphological parameters including platelet count, platelet crit, mean platelet volume [MPV] and platelet distribution width [PDW], as well as platelet activation as evidenced by measuring soluble platelet selectin [sP-selectin] level and the release of beta thromboglobulin [beta-TG], transforming growth factor beta-1 [TGF-beta1] and platelet derived factor-AA [PDGF-AA] were evaluated. The results obtained revealed significant reduction in platelet count, platelet crit and MPV while PDW was significantly increased in all LC patients in comparison to controls. sP selectin, beta-TG, TGF-beta1 and PDGF-AA revealed significant increase in all diseased when compared to control group. Patients complicated with HCC or PVT demonstrated significant increase in the aforementioned parameters in comparison to patients with LC only patients with PVT showed significant increase versus HCC patients. These findings indicate that platelet activation is a prominent feature in LC and its serious complication HCC and PVT This activation can play an important role the in pathogenesis of LC, HCC and PVT in patients with mixed schistosomiasis and viral hepatitis infections such patients need careful medical attention and effective treatment. Stabilization of the activated platelets and the dual suppression of PDGF and TGF-beta1 could be new therapeutic strategies against LC and its sequels.