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Endoscopic Cyanoacrylate Injection with Post-injection Audible Doppler Assessment of Gastric Varices: A Single-Institution Experience

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Abstract

Background and Aims

Gastric varices (GV) have higher rates of morbidity and mortality from hemorrhage than esophageal varices. Several studies have shown the safety and efficacy of cyanoacrylate (CA) injection for acute gastric variceal hemorrhage. We report data from our experience with CA injection for GV before and after routine use of post-injection audible Doppler assessment (ADA) for GV obturation and describe long-term outcomes after this therapy.

Methods

We retrospectively identified patients who had documented GV, underwent CA injection, and had at least 2 weeks of follow-up. We recorded and analyzed the survival and rebleeding rates with patient demographics, clinical data, and endoscopy findings between two groups of patients who were categorized by CA injection prior to and after inception of the ADA technique.

Results

Seventy-one patients were identified with 16 patients analyzed in a group where ADA was not used (Pre-ADA) and 55 analyzed where ADA was used (Post-ADA). No rebleeding events were observed within 1 week of initial CA injection. No embolic events were reported after any initial CA injection within 4 weeks. The rate of bleed-free survival at 1 year was 69.6% in the Pre-ADA group and 85.8% in the Post-ADA without statistical significance. The all-cause 1-year mortality was 13.8% in the Pre-ADA group and 10.7% in the Post-ADA group without statistical significance.

Conclusions

ADA of CA-injected GV does not appear to significantly affect adverse events or clinical outcomes; however, our findings are limited by small sample size and cohort proportions allowing for significant type II statistical error. Further prospective investigation is required to determine the impact of ADA on clinical outcomes after GV obturation.

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Abbreviations

ADA:

Audible Doppler assessment

BRTO:

Balloon-occluded retrograde transvenous obliteration

EUS:

En

EVH:

Esophageal variceal hemorrhage

EVL:

Endoscopic variceal ligation

GV:

Gastric varices

GVH:

Gastric variceal hemorrhage

HCC:

Hepatocellular carcinoma

HE:

Hepatic encephalopathy

MELD:

Model for end-stage liver disease

NASH:

Nonalcoholic steatohepatitis

NBCA:

N-Butyl-2-cyanoacrylate

NCPH:

Non-cirrhotic portal hypertension

PVT:

Portal vein thrombosis

TIPS:

Transjugular intrahepatic portosystemic shunt

2OCA:

2-octyl-cyanoacrylate

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Author information

Authors and Affiliations

  1. Tinsley Harrison Internal Medicine Residency Training Program, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35233, USA

    Tom D. Catron

  2. Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, VCU Medical Center, 1200 E Marshall Street, Richmond, VA, 23298, USA

    George B. Smallfield, Richard K. Sterling & Mohammad S. Siddiqui

  3. Department of Biostatistics, VCU Medical Center, 1200 E Marshall Street, Richmond, VA, 23298, USA

    Le Kang

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Contributions

Tom D. Catron—Acquisition, analysis, and interpretation of data, drafting of manuscript. George B. Smallfield—Study concept and design, critical revision of the manuscript for intellectual content, administrative and material support, study supervision. Le Kang—Statistical Analysis. Richard K. Sterling—Critical revision of the manuscript for intellectual content. Mohammad S. Siddiqui—Critical revision of the manuscript for intellectual content.

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Correspondence to George B. Smallfield.

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Catron, T.D., Smallfield, G.B., Kang, L. et al. Endoscopic Cyanoacrylate Injection with Post-injection Audible Doppler Assessment of Gastric Varices: A Single-Institution Experience. Dig Dis Sci 62, 3091–3099 (2017). https://doi.org/10.1007/s10620-017-4671-2

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