Naslov
A Randomized-Controlled Trial of Endoscopic Treatment of Acute Esophageal Variceal Hemorrhage: N-Butyl-2-Cyanoacrylate Injection vs. Variceal Ligation.

Autori
Ljubičić, Neven ; Bišćanin, Alen ; Nikolić, Marko ; Supanc, Vladimir ; Hrabar, Davor ; Pavić, Tajana ; Boban, Marko.

Izvornik
Hepato-gastroenterology (0172-6390) 58 (2011), 106; 438-443

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
esophageal varices ; hemorrhage ; cyanoacrylate ; variceal ligation

Sažetak
OBJECTIVES: Acute esophageal variceal hemorrhage is still the most serious complication of portal hypertension and esophageal variceal ligation is endoscopic treatment of choice. The aim of this prospective randomized trial was to compare the efficacy of N-butyl-2-cyanoacrylate injection and variceal ligation in the emergency endoscopic treatment of acute esophageal variceal hemorrhage in patients with portal hypertension and chronic liver disease. METHODS: From January 2004 to December 2008 43 patients with endoscopy-proven acute esophageal variceal hemorrhage were randomly assigned to one of the two treatment groups: patients undergo endoscopic injection with N- butyl-2-cyanacrylate (n=22) and patients undergoing endoscopic variceal ligation (n=21). Vital signs, the amount of blood transfusion and infection status were recorded before and after endoscopic treatment. Patients were followed-up until death or at least 4 months after the last patient was included in the study. Within two weeks after initial endoscopic treatment, prophylactic variceal ligation was started in on regular intervals until the varices were eradicated. RESULTS: Success in arresting acute bleeding was not different in the cyanoacrylate and ligation groups. The rebleeding rate was higher in the cyanoacrylate group than those undergoing ligation (13.6% vs. 4.7%) although the difference did not reach statistical difference (p=0.60692). The mean amounts of blood transfused were similar in both groups. Ten (45.5%) patients in the cyanoacrylate group and 7 (33%) patients in the ligation group died during an observational period of 14.1 ± 13.9 months and 21.0 ± 17.2 months, respectively (Log- rank test, p=0.3272). CONCLUSIONS: The efficacy of endoscopic injection therapy with N-butyl-2-cyanoacrylate to control acute esophageal variceal hemorrhage was not different to endoscopic variceal ligation and esophageal variceal rebleeding rate as well as mortality rate appears not different in those patients treated with N-butyl-2-cyanoacrylate injection than in patients treated with variceal ligation.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA