| Part 1 Long-term result of endoscopic tissue adhesive injection for treatment of gastric varicesPURPOSE:To evaluate the efficacy and safety of endoscopic tissue adhesive (N-oclyl-a-cyanoacylate) injection for treatment of gastric varices.METHODS:Data of 169 patients with gastric variceal who received tissue adhesive injection, and observed the long-term result and the side effects.RESULTS:The varices in 130 patients(76.92%) were eradicated significantly, the effective rate was 21.30%, the ineffective rate was 1.78%, the rate of early re-bleeding was 2.96%, and the rate of abnormal embolization was 1.18%.CONCLUSIONS:The method of injection of tissue adhesive under endoscopic guidance for treatment of gastric varices was convenient, safe and effective.Part 2 Tissue-adhesive obliteration of gastric varices using adjuvant lauromacrogol injection: a prospective randomized tiialPURPOSE:The aim of this prospective controlled study was to compare the efficacy and safety of the two endoscopic therapies(lipiodol-histoacr>i-lipiodol and lauromacrogolhistoacryl—lauromacrogol) in patients with gastric varices(GV).METHODS:Between March 6th, 2013 and October 16 th,2013, a total number of 298 patients with GV were admitted to our hospital for endoscopic therapy. Excluding those who did not meet the inclusion criteria, 96 patients were divided into two groups with a randomized,double-blind method.One group treated with lipiodol(lipiodo^histoacryl-lipiodol)(n=48) and another lauromacrogol(lauromacrogo^histoacryl-lauromacrogol)(n=48). Prospectively collected data of basic information, hktory of previous hemorrhage and treatment,laboratory and imaging examination results. And record infcrmation history of rebleeding,GV eradication and survival during follow-up.RESULTS:No significant difference showed between the two groups in gender, age,Child-Pugh and MELD score,etiology history of previous treatment,complications like bleeding,ascites and portal vein thrombosis, and combined diseases like hypertension, diabetes meUitus and hepatocellular carcinoma, neither did laboratory or endoscopic examination Ksults except serum albumin level with lauromacrogol group 35 ± 5g/L and lipiodol group 33 ± 5g/L(p=0.041). Histoacryl using dosage in lipiodol group was 2.0ml(1.1,2.0) and lauromacrogol group 0.5ml(0.5,1.0),p=0.000. and for those with GV diameter l-2cm,the histocaryl dosage using in lipiodol and lauromacrogol group was L8 ± 1.3ml and 0.9 ± 0.6ml respectively(p=0.000),and for those with GV diameter>2cm, the volume was 2.4 ± 0.9ml and 0.8±0.4ml, respectively( p=0.000).The median cost of lipiodol group was 3325 RMB(1925, 3325),and lauromacrogol group 1399 RMB y 399, 2798(p=0.000). No serious adverse events occurred in either group. 10(10.6) of the 94 patients received follow-up developed uppergastrointestinai hemorrhage with five in each group(p=l ?000). Each group had one case died of rebleeding.CONCLUSIONS:No confirmed evidence showed lauromacrogol-histocaryl-lauromacrogoJ works better than the traditional "sandwich" treatment(lipiodol-histoacry-lipiodol) in reducing the rate of GV rebleeding. However, lauromacrogol combined with Histocaiyl treatment has been confirmed to be safe and it does reduce the histocaryl using dosage and cost of treatment. Nevertheless,randomized controlled trials implemented strictly with multi-center,large sample size and enough follow-up time are needed in fiiture r search. |
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