Sclerosis of fundic varices. Experience in a reference center in the South West of Colombia. 2011-2017

Catalina Maldonado

Abstract


Abstract: Treatment of variceal bleeding in the esophagus and fundus is a clinic challenge which sometimes leads to seeking alternative management for this type of patients. This study was carried out to make known the demographic characteristics of patients with gastric varices with or without the presence of esophageal varices that were taken to cyanocrylate sclerotherapy (CYP). Endoscopic findings, outcomes and complications are described. Data used to evaluate the safety and efficacy of the procedure in the management of patients with or without active variceal bleeding.

This observational descriptive retrospective cross-sectional study included patients with manifest portal hypertension with esophageal and fundic varices, a total of 132 sclerotherapy procedures with cyanoacrylate mixed with lipiodol.

We included 132 records of sclerotherapy with CYA, with equal gender distribution. Esophageal varices were found in 90.2% (119 records). In 31 procedures the indication was emergency bleeding (23.5%), of these 7 had CP-A, 12 CP-B, 0 CP-C and 12 without data. Out of the 101 elective interventions, 34 had CP-A, 24 CP-B, 6 CP-C and 37 without data, with no significant differences between groups (p value = 0.1). Homeostasis was achieved in 100% of patients with active bleeding. Varice sclerosis was successful with a single puncture in 81.1%, two punctures in 13.6% and three or more in 5.3% of the procedures. There were no complications in any of the patients, nor damage in the equipment used. In conclusión  Endoscopic obliteration of fundic varices with CYP was safe and effective in the treatment of upper gastric variceal bleeding, without clinical complications in the procedure or damage to the endoscopic equipment used.


Keywords


Portal hypertension, varicose vein sclerosis, cirrhosis.

References


Møller S, Bendtsen F. Complications of cirrhosis. A 50 years flashback. Scand J Gastroenterol. 2015;(February): 1-18.

doi:10.3109/00365521.2015.1021709.

Ge PS, Runyon BA. Treatment of Patients with Cirrhosis. N Engl J Med. 2016;375(8):767- 777. doi:10.1056/NEJMra1504367.

Bosch J. Pharmacological Treatment of Portal Hypertension: An Evidence-Based Approach. 2000;20(3).

La Brecque D, Khan AG, Sarin SK, Le Mair AW. Esophageal Varices. WGO Pract Guidel. 2015:2-15.

Koch D. Update in the management of gastric varices. Curr Opin Gastroenterol. 2016; 32(3):1. doi:10.1097/MOG.0000000000000267.

Iwakiri Y, Groszmann RJ. Vascular endothelial dysfunction in cirrhosis. J Hepatol. 2007;46(5):927-934. doi:10.1016/j.jhep.2007.02.006.

Garcia-tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362(9):823-832.

doi:10.1056/NEJMra0901512.

Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922- 938.

doi:10.1002/hep.21907.

Kamath PS, Mookerjee RP. Individualized care for portal hypertension: Not quite yet. J Hepatol. 2015;63(3):543-545. doi:10.1016/j.jhep.2015.05.022.

Kim SJ, Rhee KW, Kim KM. Endoscopic cyanoacrylate injection for the treatment of gastric varices in children. World J Gastroenterol. 2015;21(9):2719-2724. doi:10.3748/wjg.v21.i9.2719.

Lizardo-sanchez L, Burdick J, Trotter JF. Safety and efficacy of 2-octyl-cyanoacrylate in the management of patients with gastric and duodenal varices who are not candidates for transjugular intrahepatic portosystemic shunts. 2016;29(4):371-373.

Tantau M, Crisan D, Popa D, Vesa S, Tantau A. Band ligation vs. N-Butyl-2- cyanoacrylate injection in acute gastric variceal bleeding: A prospective follow-up study. Ann Hepatol. 2014;13(1):75-83.

Shi B, Wu W, Zhu H, Wu YL. Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol. World J Gastroenterol. 2008;14(22):3598-601.

Procaccini NJ, Al-Osaimi AMS , Northup P, Argo C, Caldwell SH . Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc (2009); 70 (5), 881 – 887.

Er C, Seron P, Jp G, X BC. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in patients with portal hypertension (Protocol). 2012;(10). doi:10.1002/14651858.CD010180.pub2.

Rengstorff DS, Binmoeller KF . A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans. Gastrointest, (2004), Endosc; 59 ( 4), 553 – 558.

Smith MR, Tidswell R, Tripathi D. Outcomes of endoscopic human thrombin injection in the management of gastric varices. Eur J Gastroenterol Hepatol. 2014; 26(8) : 846 - 852. doi:10.1097/MEG.0000000000000119.

Bhat YM, Weilert F, Fredrick RT, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: A large U.S. experience over 6 years (with video). Gastrointest Endosc. 2016;83(6):1164-1172. doi:10.1016/j.gie.2015.09.040.

Hall PSJ, Teshima C, May GR, Mosko JD. Endoscopic Ultrasound-Guided Vascular Therapy : The Present and the Future. 2017:138-142.

Martínez-gonzález, J., López-durán, S., Vázquez-sequeiros, E., & Albillos-martínez, A. Management of fundic varices . Endoscopic aspects, (2015). 107, 501–508.

Chung, C., & Wang, H. Application of Endoscopy in Improving Survival of Cirrhotic Patients with Acute Variceal Hemorrhage, 2011. https://doi.org/10.4061/2011/893973

Rathbun, S., Norris, A., Morrison, N., Gibson, K., Hohenwalter, E., & Lohr, J. Phlebology. (2012). https://doi.org/10.1258/phleb.2011.010101

Sarin, S. K., Jain, A. K., & Jain, M. A Randomized Controlled Trial of Cyanoacrylate Versus Alcohol Injection in Patients With Isolated Fundic Varices, (2002). 97(4), 0–5.

Endoscopic injection sclerotherapy versus N-Butyl-2 Cyanoacrylate injection in the management of actively bleeding esophageal varices: a randomized controlled trial. BMC Gastroenterol. 2019 Feb 4;19(1): 23. doi: 10.1186/s12876-019-0940-1.


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