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http://dx.doi.org/10.3904/kjim.2015.30.5.593

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)
Publication Information
The Korean journal of internal medicine / v.30, no.5, 2015 , pp. 593-601 More about this Journal
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
Cyanoacrylates; Esophageal and gastric varices; Hemostasis; Endoscopic; Proton pump inhibitors; Treatment outcome;
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1 Sarin SK, Kumar A. Gastric varices: profile, classification, and management. Am J Gastroenterol 1989;84:1244-1249.
2 Watanabe K, Kimura K, Matsutani S, Ohto M, Okuda K. Portal hemodynamics in patients with gastric varices: a study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology 1988;95:434-440.   DOI
3 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;16:1343-1349.   DOI
4 Sarin SK. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc 1997;46:8-14.   DOI
5 Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W; Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46:922-938.   DOI
6 Huang YH, Yeh HZ, Chen GH, et al. Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety. Gastrointest Endosc 2000;52:160-167.   DOI
7 Mumtaz K, Majid S, Shah H, et al. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding. World J Gastroenterol 2007;13:1247-1251.   DOI
8 Fry LC, Neumann H, Olano C, Malfertheiner P, Monkemuller K. Efficacy, complications and clinical outcomes of endoscopic sclerotherapy with N-butyl-2-cyanoacrylate for bleeding gastric varices. Dig Dis 2008;26:300-303.   DOI
9 Oho K, Iwao T, Sumino M, Toyonaga A, Tanikawa K. Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy 1995;27:349-354.   DOI
10 Akahoshi T, Hashizume M, Shimabukuro R, et al. Longterm results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience. Surgery 2002;131(1 Suppl):S176-S181.   DOI
11 Park WG, Yeh RW, Triadafilopoulos G. Injection therapies for variceal bleeding disorders of the GI tract. Gastrointest Endosc 2008;67:313-323.   DOI
12 Hidaka H, Nakazawa T, Wang G, et al. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial. J Gastroenterol 2012;47:118-126.   DOI
13 Kok K, Bond RP, Duncan IC, et al. Distal embolization and local vessel wall ulceration after gastric variceal obliteration with N-butyl-2-cyanoacrylate: a case report and review of the literature. Endoscopy 2004;36:442-446.   DOI
14 Gimson A, Polson R, Westaby D, Williams R. Omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy. Gastroenterology 1990;99:1829-1831.   DOI
15 Shaheen NJ, Stuart E, Schmitz SM, et al. Pantoprazole reduces the size of postbanding ulcers after variceal band ligation: a randomized, controlled trial. Hepatology 2005;41:588-594.   DOI
16 de Franchis R, Baveno VF. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010;53:762-768.   DOI
17 Hashizume M, Kitano S, Yamaga H, Koyanagi N, Sugimachi K. Endoscopic classification of gastric varices. Gastrointest Endosc 1990;36:276-280.   DOI
18 Tan PC, Hou MC, Lin HC, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 2006;43:690-697.   DOI
19 de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001;5:645-663.   DOI
20 Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986;32:264-268.   DOI
21 Kim T, Shijo H, Kokawa H, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology 1997;25:307-312.   DOI
22 Arakawa M, Masuzaki T, Okuda K. Pathomorphology of esophageal and gastric varices. Semin Liver Dis 2002;22:73-82.   DOI
23 Toriumi DM, Raslan WF, Friedman M, Tardy ME Jr. Variable histotoxicity of histoacryl when used in a subcutaneous site: an experimental study. Laryngoscope 1991;101(4 Pt 1):339-343.   DOI
24 Kind R, Guglielmi A, Rodella L, et al. Bucrylate treatment of bleeding gastric varices: 12 years' experience. Endoscopy 2000;32:512-519.   DOI