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Clinical Investigation of Portal Hypertension pp 327–338Cite as

Choice of Therapy for Gastric Variceal Bleeding: Results from a Cohort Study in Japan

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Abstract

There are many therapies to treat bleeding gastric varices, but comparative studies for gastric variceal bleeding have not identified which therapy is superior to all others. The Japan Society for Portal Hypertension created a registry of bleeding gastric varices for over 5 years at 31 major institutions. A variety of therapies performed in Japan during these 5 years were compared and evaluated. For emergencies, cyanoacrylate with Lipiodol injection via endoscopy was significantly more effective than conservative therapies. Balloon-occluded retrograde transvenous obliteration (B-RTO) and surgery were also effective for preventing rebleeding.

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References

  1. Hassab MA. Gastro-esophageal decongestion and splenectomy GEDS (Hassab), in the management of bleeding varices; review of literature. Int Surg. 1998;83:38–41.

    CAS  PubMed  Google Scholar 

  2. Tomikawa M, Hashizume M, Saku M, Tanoue K, Ohta M, Sugimachi K. Effectiveness of gastric devascularization and splenectomy for patients with gastric varices. J Am Coll Surg. 2000;191:498–503.

    Article  CAS  Google Scholar 

  3. Sarin SK, Sachdev G, Nanda R, Misra SP, Broor SL. Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg. 1988;75:747–50.

    Article  CAS  Google Scholar 

  4. Gimson AE, Westaby D, Williams R. Endoscopic sclerotherapy in the management of gastric variceal haemorrhage. J Hepatol. 1991;13:274–8.

    Article  CAS  Google Scholar 

  5. Soehendra N, Grimm H, Nam VC, Berger B. N-butyl-2-cyanoacrylate: a supplement to endoscopic sclerotherapy. Endoscopy. 1987;19:221–4.

    Article  CAS  Google Scholar 

  6. Stoesslein F, Ditscherlein G, Romaniuk PA. Experimental studies on new liquid embolization mixtures (histoacryl-lipiodol, histoacryl-panthopaque). Cardiovasc Intervent Radiol. 1982;5:264–7.

    Article  CAS  Google Scholar 

  7. Seewald S, Ang TL, Imazu H, Naga M, Omar S, Groth S, et al. A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices. Gastrointest Endosc. 2008;68:447–54.

    Article  Google Scholar 

  8. Ogawa K, Ishikawa S, Naritaka Y, Shimakawa T, Wagatsuma Y, Katsube A, et al. Clinical evaluation of endoscopic injection sclerotherapy using n-butyl-2-cyanoacrylate for gastric variceal bleeding. J Gastroenterol Hepatol. 1999;14:245–50.

    Article  CAS  Google Scholar 

  9. Ramond MJ, Valla D, Mosnier JF, Degott C, Bernuau J, Rueff B, et al. Successful endoscopic obturation of gastric varices with butyl cyanoacrylate. Hepatology. 1989;10:488–93.

    Article  CAS  Google Scholar 

  10. Feretis C, Tabakopoulos D, Benakis P, Xenofontos M, Golematis B. Endoscopic hemostasis of esophageal and gastric variceal bleeding with Histoacryl. Endoscopy. 1990;22:282–4.

    Article  CAS  Google Scholar 

  11. D’Imperio N, Piemontese A, Baroncini D, Billi P, Borioni D, Dal Monte PP, et al. Evaluation of undiluted N -butyl-2 -cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy. 1996;28:239–43.

    Article  Google Scholar 

  12. Marques P, Maluf-Filho F, Kumar A, Matuguma SE, Sakai P, Ishioka S. Long-term outcomes of acute gastric variceal bleeding in 48 patients following treatment with cyanoacrylate. Dig Dis Sci. 2008;53:544–50.

    Article  CAS  Google Scholar 

  13. Huang YH, Yeh HZ, Chen GH, Chang CS, Wu CY, Poon SK, et al. Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety. Gastrointest Endosc. 2000;52:160–7.

    Article  CAS  Google Scholar 

  14. Akahoshi T, Hashizume M, Shimabukuro R, Tanoue K, Tomikawa M, Okita K, et al. Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery. 2002;131:S176–81.

    Article  Google Scholar 

  15. Obara K, Ohira H, Sakamoto H, Iwasaki K, Morito T, Kasukawa R. Endoscopic injection sclerotherapy with alpha-cyanoacrylate monomer for emergent bleeding from isolated gastric varices—report of 3 cases. Gastroenterol Endsc. 1989;32:3209–16. (In Japanese).

    Google Scholar 

  16. Shiha G, El-Sayed SS. Gastric variceal ligation: a new technique. Gastrointest Endosc. 1999;49:437–41.

    Article  CAS  Google Scholar 

  17. Koutsomanis D. Endoscopic clipping for bleeding varices. Gastrointest Endosc. 1994;40:126–7.

    Article  CAS  Google Scholar 

  18. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11:51–8.

    Article  CAS  Google Scholar 

  19. Hiraga N, Aikata H, Takaki S, Kodama H, Shirakawa H, Imamura M. The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol. 2007;42:663–72.

    Article  Google Scholar 

  20. Shiba M, Higuchi K, Nakamura K, Itani A, Kuga T, Okazaki H, et al. Efficacy and safety of balloon-occluded endoscopic injection sclerotherapy as a prophylactic treatment for high-risk gastric fundal varices: a prospective, randomized, comparative clinical trial. Gastrointest Endosc. 2002;56:522–8.

    Article  Google Scholar 

  21. Matsumoto A, Hamamoto N, Nomura T, Hongou Y, Arisaka Y, Morikawa H, et al. Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices. Am J Gastroenterol. 1999;94:643–9.

    Article  CAS  Google Scholar 

  22. Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:1010–5.

    Article  CAS  Google Scholar 

  23. Yoshida T, Hayashi N, Suzumi N, Miyazaki S, Terai S, Itoh T, et al. Endoscopic ligation of gastric varices using a detachable snare. Endoscopy. 1994;26:502–5.

    Article  CAS  Google Scholar 

  24. Harada T, Yoshida T, Shigemitsu T, Takeo Y, Tada M, Okita K. Therapeutic results of endoscopic variceal ligation for acute bleeding of oesophageal and gastric varices. J Gastroenterol Hepatol. 1997;12:331–5.

    Article  CAS  Google Scholar 

  25. Yoshida T, Harada T, Shigemitsu T, Takeo Y, Miyazaki S, Okita K. Endoscopic management of gastric varices using a detachable snare and simultaneous endoscopic sclerotherapy and O-ring ligation. J Gastroenterol Hepatol. 1999;14:730–5.

    Article  CAS  Google Scholar 

  26. Barange K, Péron JM, Imani K, Otal P, Payen JL, Rousseau H, et al. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology. 1999;30:1139–43.

    Article  CAS  Google Scholar 

  27. Oho K, Iwao T, Sumino M, Toyonaga A, Tanikawa K. Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy. 1995;27:349–54.

    Article  CAS  Google Scholar 

  28. 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;13:75–83.

    CAS  Google Scholar 

  29. Mahadeva S, Bellamy MC, Kessel D, Davies MH, Milson XE. Cost-effectiveness of N-butyl-2-cyanoacrylate (histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of acute gastric variceal bleeding. Am J Gastroenterol. 2003;98:2688–93.

    Article  CAS  Google Scholar 

  30. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33:1060–4.

    Article  CAS  Google Scholar 

  31. Maluf-Filho F, Sakai P, Ishioka S, Matsuguma SE. Sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, randomized study and in Child-Pugh class C patients. Endoscopy. 2001;33:421–7.

    Article  CAS  Google Scholar 

  32. Lo GH, Liang HL, Chen WC, Chen MH, Lai KH, Hsu PI, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39:679–85.

    Article  Google Scholar 

  33. Hong CH, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, et al. Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2 cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteralition. J Gastroenterol Hepatol. 2009;24:372–8.

    Article  Google Scholar 

  34. Murashima N, Watanabe N, Ohta M, Obara K, Oho K, Kokubu S, et al. Evaluation of the therapies for bleeding gastric varices in Japan; a retrospective multi-center cohort study. Jpn J Portal Hypertens. 2010;16:88–103. (in Japanese).

    Google Scholar 

  35. Tajiri T, Yoshida H, Obara K, Onji M, Kage M, Kitano S, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc. 2010;22:1–9.

    Article  Google Scholar 

  36. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16:1343–9.

    Article  CAS  Google Scholar 

  37. Fry LC, Neumann H, Olano C. Efficacy, complications and clinical outcomes of endoscopic sclerotherapy with N-butyl-2-cyanoacrylate for bleeding gastric varices. Dig Dis. 2008;26:300–3.

    Article  Google Scholar 

  38. Alexander S, Korman MG, Sievert W. Cyanoacrylate in the treatment of gastric varices complicated by multiple pulmonary emboli. Intern Med J. 2006;36:462–5.

    Article  CAS  Google Scholar 

  39. Singer AD, Fananapazir G, Maufa F, Narra S, Ascher S. Pulmonary embolism following 2-octyl-cyanoacrylate/lipiodol injection for obliteration of gastric varices: an imaging perspective. J Radiol Case Rep. 2012;6:17–22.

    PubMed  PubMed Central  Google Scholar 

  40. García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370–9.

    Article  Google Scholar 

  41. de Franchis R, Faculty Baveno V. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–8.

    Article  Google Scholar 

  42. Weil D, Cervoni JP, Fares N, Rudler M, Bureau C, Plessier A, et al. Management of gastric varices: a French national survey. Eur J Gastroenterol Hepatol. 2016;28:576–81.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Mishuku Hospital, Tokyo, Japan

    Naoya Murashima

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  1. Naoya Murashima
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Correspondence to Naoya Murashima .

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Editors and Affiliations

  1. Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan

    Katsutoshi Obara

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Murashima, N. (2019). Choice of Therapy for Gastric Variceal Bleeding: Results from a Cohort Study in Japan. In: Obara, K. (eds) Clinical Investigation of Portal Hypertension. Springer, Singapore. https://doi.org/10.1007/978-981-10-7425-7_33

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  • DOI: https://doi.org/10.1007/978-981-10-7425-7_33

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-7424-0

  • Online ISBN: 978-981-10-7425-7

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