Results of endoscopic sclerotherapy with n-butyl-2-cyanoacrylate versus ethanolamine oleate in treatment of bleeding gastric varices

ABSTRACT

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