[Show abstract][Hide abstract] ABSTRACT: To compare the efficacy of modified percutaneous transhepatic variceal embolization (PTVE) with 2-octyl-cyanoacrylate (2-OCA) and endoscopic variceal obturation (EVO) with an injection of 2-OCA for prophylaxis of gastric variceal rebleeding.
In this retrospective study, the medical records of liver cirrhosis patients with gastric variceal bleeding who underwent either endoscopic 2-OCA (EVO) or modified PTVE using 2-OCA at Shandong Provincial Hospital from January 2006 to December 2008 were reviewed. Patient demographics, rebleeding rate, survival rate, and complications were compared between the two groups (PTVE and EVO). All results were expressed as mean ± SD, or as a percentage. Quantitative variables were compared by two sample Student t tests, and qualitative variables were compared by the Fisher exact test or the χ(2) test (with Yates correction) where appropriate. A P value less than 0.05 was considered significant. Statistical computation was performed using SPSS 13.0 software.
A total of 77 patients were included; 45 patients who underwent EVO and 32 patients who received PTVE. During the follow-up (19.78 ± 7.70 mo in the EVO group, vs 21.53 ± 8.56 mo in the PTVE group) rebleeding occurred in 17 patients in the EVO group and in 4 patients in the PTVE group (37.78% vs 12.5%, P = 0.028). The cumulative rebleeding-free rate was 75%, 59%, and 49% in 1, 2, and 3 years respectively for EVO, and 93%, 84%, and 84% for PTVE (P = 0.011). Cox analysis was used to identify independent factors that predicted rebleeding after treatment. Variables including age, gender, cause, Child-Pugh classification, size of gastric varices (GV), location of GV, and treatment methods were analyzed. It was revealed that Child-Pugh classification [risk ratio (RR) 2.10, 95%CI: 1.03-4.28, P = 0.040], choice of treatment (RR 0.25, 95%CI: 0.08-0.80, P = 0.019), and size of GV (RR 2.14, 95%CI: 1.07-4.28, P = 0.032) were the independent factors for predicting rebleeding. Follow-up computed tomography revealed that cyanoacrylate was retained in the varices and in the feeding veins of PTVE patients. During the follow-up, eight patients in the EVO group and four patients in the PTVE group died. The cumulative survival rates at 1, 2, and 3 years were 93%, 84%, and 67% respectively in the EVO group, and 97%, 88%, and 74% respectively in the PTVE group. The survival rates were not significantly different between the two groups (P = 0.432). Cox analysis showed that the Child-Pugh classification was the most significant prognostic factor of survival (RR 2.77, 95%CI: 1.12-6.80, P = 0.027). The incidence of complications was similar in both groups.
With extensive and permanent obliteration of gastric varices and its feeding veins, PTVE with 2-OCA is superior to endoscopic 2-OCA injection for preventing gastric variceal rebleeding.
Preview · Article · Feb 2013 · World Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus embolotherapy in the treatment of patients with gastroesophageal varices.
A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University. The rechecked items included abdominal ultrasound examination, liver function test and blood routine examination at Day 7 post-operation. All received endoscopic examinations at Month 1.
The technical success rate of TIPS plus embolotherapy was 100%. The portal vein pressures declined from (28 ± 8) mm Hg (1 mm Hg = 0.133 kPa) to (14 ± 7) mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients. Both liver function and gastroesophageal varices markedly improved. During the follow-up period of 3 - 6 months, 4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation. And most cases were resolved after treatment. No rebleeding occurred during the follow-up period.
The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension, it has great clinical values in the treatment of portal hypertension and gastroesophageal varices.
No preview · Article · Feb 2012 · Zhonghua yi xue za zhi
[Show abstract][Hide abstract] ABSTRACT: To test the safety and validity of percutaneous transhepatic variceal embolization (PTVE) with tissue adhesive cyanoacrylate.
PTVE with cyanoacrylate was performed on 92 patients with gastroesophageal varices, 53 males and 39 females, aged 62.5 (7-84): cyanoacrylate was injected into the varices and the afferent veins. Endoscopy and CT were performed to evaluate the embolization.
PTVE was successfully completed in 89 of the 92 patients with a technical success rate of 96.7%, and 3 patients died within 1 month. Among the other 86 patients 3 types of cyanoacrylate embolization were achieved: embolization of coronary vein, vessels around gastric fundus, and variceal lower esophagus veins in 40 patients, embolization of coronary vein, gastric fundus and pericardial varices in 33 patients, and embolization of sole gastric coronary vein stem in 13 patients. Acute variceal bleeding in 18 patients was immediately arrested after the procedure, with an acute bleeding control rate of 100%. Eighty-six patients were followed up for 31.5 (6-52) months. The general variceal recurrence rate was 14.1% (10/71), and the variceal recurrence rate of the coronary vein embolization group was 100% (2/2), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 17.2% (5/29) respectively, P = 0.006]. The general rebleeding rate was 16.3% (14/86), and the rebleeding rates of the group of coronary vein embolization was 69.2% (9/13), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 15. 2% (5/33) respectively, P = 0.0092]. No obvious ectopic embolization was found. The mortality was 24.7% (22/89). The cause of rebleeding in coronary vein embolization was mainly recurrent variceal bleeding, whereas that in the group of fundus and esophagus variceal embolization was mainly hypertensive gastropathy.
PTVE with cyanoacrylate is safe and effective for the obliteration of gastroesophageal varices in cirrhotic patients.
No preview · Article · Jan 2008 · Zhonghua yi xue za zhi
[Show abstract][Hide abstract] ABSTRACT: To study the clinical efficacy of TH glue (cyanoacrylate) obliteration of esophageal varices and partial spleen embolization (PSE) in the treatment of esophageal varices bleeding.
TH glue was injected into the gastroesophageal varices and their feeder veins in 84 patients. According to the size of the varices and their blood flow, the TH glue was injected alone or after a steel coil was placed at the ostium of the feeder vein. Sometimes absolute alcohol was also injected into the varices. PSE was performed after the TH glue obliteration in all patients.
(1) The TH glue obliteration was performed on 81 patients with a success rate of 96.4%. Three patients died from the procedure. (2) The left gastric vein coronary, gastric varices, pericardial varices, and lower esophageal veins were obliterated in 38 patients (group 1). Left gastric vein, gastric varices, and pericardial veins were obliterated in 31 patients (group 2). Only the main gastric coronary vein was obliterated in 9 patients (group 3). The disappearance rate of the esophageal varices was 71.1% (27/38), 35.5% (11/31) and 0% (0/9) in the three groups. (3) During a follow-up of 6-49 months, rebleeding occurred in 13 of all 78 (16.7%) patients, and it was 7.9% (3/38), 12.9% (4/31) and 66.7% (6/9) respectively in the three groups.
Our results suggest percutaneous transhepatic TH glue obliteration of esophageal varices and PSE are safe and effective in treating gastroesophageal varicose bleeding.
No preview · Article · Nov 2007 · Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology