The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Can proton pump inhibitors reduce rebleeding following Histoacryl sclerotherapy for gastric variceal hemorrhage?

  • Kim, Ka Rham (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Jun, Chung Hwan (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Cho, Kyu Man (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Wi, Jin Woo (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Park, Seon Young (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Cho, Sung Bum (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lee, Wan Sik (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Park, Chang Hwan (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Joo, Young Eun (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Hyun Soo (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Choi, Sung Kyu (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Rew, Jong Sun (Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2014.06.21
  • Accepted : 2014.09.22
  • Published : 2015.09.01
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Abstract

Background/Aims: To evaluate the efficacy of proton pump inhibitors (PPIs) in reducing rebleeding and bleeding-related death rates after endoscopic gastric variceal obliteration (GVO) using N-butyl-2-cyanoacrylate (NBC). Methods: This study enrolled 341 patients who were consecutively diagnosed with and treated for bleeding gastric varices. The patients were divided into PPI and non-PPI groups, and their endoscopic findings, initial hemostasis outcomes, rebleeding and bleeding-related death rates, and treatment-related complications were analyzed. Results: The rate of initial hemostasis was 97.1%. rebleeding occurred in 2.2% of patients within 2 weeks, 3.9% of patients within 4 weeks, 18.9% of patients within 6 months, and 27.6% of patients within 12 months of the GVO procedure. A previous history of variceal bleeding (relative risk [RR], 1.955; 95% confidence interval [CI], 1.263 to 3.028; p = 0.003) and use of PPIs (RR, 0.554; 95% CI, 0.352 to 0.873; p = 0.011) were associated with rebleeding. Child-Pugh class C (RR, 10.914; 95% CI, 4.032 to 29.541; p < 0.001), failure of initial hemostasis (RR, 13.329; 95% CI, 2.795 to 63.556; p = 0.001), and the presence of red-colored concomitant esophageal varices (RR, 4.096; 95% CI, 1.320 to 12.713; p = 0.015) were associated with bleeding-related death. Conclusions: The prophylactic use of PPIs reduces rebleeding after GVO using NBC in patients with gastric variceal hemorrhage. However, prophylactic use of PPIs does not reduce bleeding-related death.

Keywords

Acknowledgement

Supported by : Chonnam National University Hospital

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