PDF(Pubmed)
Abstract：
UNASSIGNED: Gastric variceal bleeding (GVB), compared to esophageal varices, is rare but often massive and associated with high mortality. Endoscopic cyanoacrylate glue injection (ECGI) is the first-line treatment for GVB. Hence, we conducted this study to assess the clinical outcomes and the determinants of ECGI for gastric variceal bleeding.
UNASSIGNED: This was a prospective observational study of patients with ECGI for GVB between June 2019 and February 2023. The demographic characteristics, etiology and severity of cirrhosis, size, type of gastric varices, volume of cyanoacrylate used, number of sessions required, technical success, rebleeding rate, and survival at three months were studied.
UNASSIGNED: A total of 135 patients underwent ECGI for GVB. Their mean (SD) age was 44.9 (13.6) years, with a male preponderance (n = 23, 68.1 %). Eighty-two patients (60.7 %) had cirrhosis. Their mean model for end-stage liver disease (MELD) score was 14.3 (7.3). Gastric varices were gastroesophageal varices (GOV)1 in 42 (31.1 %), GOV2 in 73 (54.1 %), and isolated gastric varices (IGV)1 in 20 (14.8 %) patients. Varices were large in 35 (25.9 %) and had F1 morphology in 89 (65.9 %) patients. The success rate of initial hemostasis was 98.5 %. The median sessions required were 1 (1-2), and the median volume of cyanoacrylate per session was 2 (1-2) ml. The procedure was associated with minor complications like transient abdominal pain in 11 (8.1 %) and fever in 2 (2.7 %) patients. Rebleeding was observed in 23 (17 %) patients. GOV2, F1 morphology, and a high MELD score were significantly associated with rebleeding. Five (3.7 %) patients died during the study; 2 (1.5 %) were due to failure to control bleeding.
UNASSIGNED: In conclusion, our study demonstrated ECGI to be very safe and effective for GVB. The technical success was high and could be achieved in fewer sessions with a smaller volume of cyanoacrylate during each session.
UNASSIGNED: This was a prospective observational study of patients with ECGI for GVB between June 2019 and February 2023. The demographic characteristics, etiology and severity of cirrhosis, size, type of gastric varices, volume of cyanoacrylate used, number of sessions required, technical success, rebleeding rate, and survival at three months were studied.
UNASSIGNED: A total of 135 patients underwent ECGI for GVB. Their mean (SD) age was 44.9 (13.6) years, with a male preponderance (n = 23, 68.1 %). Eighty-two patients (60.7 %) had cirrhosis. Their mean model for end-stage liver disease (MELD) score was 14.3 (7.3). Gastric varices were gastroesophageal varices (GOV)1 in 42 (31.1 %), GOV2 in 73 (54.1 %), and isolated gastric varices (IGV)1 in 20 (14.8 %) patients. Varices were large in 35 (25.9 %) and had F1 morphology in 89 (65.9 %) patients. The success rate of initial hemostasis was 98.5 %. The median sessions required were 1 (1-2), and the median volume of cyanoacrylate per session was 2 (1-2) ml. The procedure was associated with minor complications like transient abdominal pain in 11 (8.1 %) and fever in 2 (2.7 %) patients. Rebleeding was observed in 23 (17 %) patients. GOV2, F1 morphology, and a high MELD score were significantly associated with rebleeding. Five (3.7 %) patients died during the study; 2 (1.5 %) were due to failure to control bleeding.
UNASSIGNED: In conclusion, our study demonstrated ECGI to be very safe and effective for GVB. The technical success was high and could be achieved in fewer sessions with a smaller volume of cyanoacrylate during each session.
摘要：
■胃底静脉曲张破裂出血（GVB），与食管静脉曲张相比，是罕见的，但往往是巨大的，并与高死亡率有关。内镜下氰基丙烯酸酯胶注射（ECGI）是GVB的一线治疗方法。因此，本研究旨在评估胃底静脉曲张出血的临床结局和ECGI的决定因素.
■这是一项针对2019年6月至2023年2月的ECGIGVB患者的前瞻性观察性研究。人口特征，肝硬化的病因和严重程度，尺寸,胃静脉曲张类型,使用的氰基丙烯酸酯的体积，所需的会话数量，技术上的成功,再出血率,研究了三个月时的生存率。
■共有135例患者接受了GVB的ECGI治疗。他们的平均年龄（SD）为44.9（13.6）岁，男性占优势(n=23，68.1%)。82例患者（60.7％）患有肝硬化。他们的终末期肝病（MELD）评分的平均模型为14.3（7.3）。胃静脉曲张为胃食管静脉曲张(GOV)1/42(31.1%),GOV2为73（54.1%），20例(14.8%)患者中孤立性胃静脉曲张(IGV)1例。35例(25.9%)静脉曲张较大，89例(65.9%)有F1形态。初次止血成功率为98.5%。所需的会议中位数为1（1-2），每个疗程的氰基丙烯酸酯的中位体积为2（1-2）ml。该手术与11例（8.1％）的短暂性腹痛和2例（2.7％）的发烧等轻微并发症有关。23例（17%）患者出现再出血。GOV2,F1形态,高MELD评分与再出血显著相关.研究期间有5例（3.7％）患者死亡；2例（1.5％）是由于未能控制出血。
■总而言之，我们的研究表明，ECGI对GVB非常安全有效。技术成功很高，可以在较少的会议中实现，每次会议期间氰基丙烯酸酯的体积较小。
■这是一项针对2019年6月至2023年2月的ECGIGVB患者的前瞻性观察性研究。人口特征，肝硬化的病因和严重程度，尺寸,胃静脉曲张类型,使用的氰基丙烯酸酯的体积，所需的会话数量，技术上的成功,再出血率,研究了三个月时的生存率。
■共有135例患者接受了GVB的ECGI治疗。他们的平均年龄（SD）为44.9（13.6）岁，男性占优势(n=23，68.1%)。82例患者（60.7％）患有肝硬化。他们的终末期肝病（MELD）评分的平均模型为14.3（7.3）。胃静脉曲张为胃食管静脉曲张(GOV)1/42(31.1%),GOV2为73（54.1%），20例(14.8%)患者中孤立性胃静脉曲张(IGV)1例。35例(25.9%)静脉曲张较大，89例(65.9%)有F1形态。初次止血成功率为98.5%。所需的会议中位数为1（1-2），每个疗程的氰基丙烯酸酯的中位体积为2（1-2）ml。该手术与11例（8.1％）的短暂性腹痛和2例（2.7％）的发烧等轻微并发症有关。23例（17%）患者出现再出血。GOV2,F1形态,高MELD评分与再出血显著相关.研究期间有5例（3.7％）患者死亡；2例（1.5％）是由于未能控制出血。
■总而言之，我们的研究表明，ECGI对GVB非常安全有效。技术成功很高，可以在较少的会议中实现，每次会议期间氰基丙烯酸酯的体积较小。
