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Role and safety of human thrombin injection for the treatment of bleeding gastric varices

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Abstract

Background

Human thrombin appears to be a new effective tool in the armamentarium of management of bleeding gastric varices, but there are paucity of data on its use. Thus, we share our experience with human thrombin in the treatment of bleeding gastric varices.

Methods

It was a prospective interventional study conducted between September 2015 and December 2017. Patients with upper gastrointestinal bleeding from gastric varices were included, while patients with previous history of cyanoacrylate glue injection or band ligation were excluded.

Results

A total of 20 patients including 13 males (mean age 32.65 [18–52] years) presenting with gastric variceal bleeding requiring endoscopic injection of human thrombin were studied. The underlying diagnosis was cirrhosis in 8 patients, and extrahepatic portal vein thrombosis, noncirrhotic portal fibrosis, and chronic pancreatitis in 6, 4, and 2 patients, respectively. Isolated gastric varices were found in 6 patients while 14 patients had gastroesophageal varices (GOV) (GOV1–3, GOV2–11). Patients received 1 to 3 sessions (mean = 1.3) of thrombin with a mean total dose of 700 IU (range = 500–2000 IU). Mean follow up was 16.8 months (range 3–28 months). Hemostasis in the acute setting was successfully managed in all the 20 patients on initial presentation. On serial follow up, 4 out of 20 patients required repeat endoscopic session for gastric varices. No thrombin injection-related complication was recorded.

Conclusion

Endoscopic therapy with thrombin appears safe and effective in the management of bleeding gastric varices.

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Authors and Affiliations

  1. Department of Gastroenterology, Sawai Man Singh Medical College and Hospital, House No. 109, Shiv Vihar VKI Infront of Road No. 5, Sikar Road, Jaipur, 302 029, India

    Ashok Jhajharia, Shashank J. Wanjari, Prachis Ashdhir, Rupesh Pokharna & Sandeep Nijhawan

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  1. Ashok Jhajharia
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  2. Shashank J. Wanjari
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  3. Prachis Ashdhir
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Correspondence to Ashok Jhajharia.

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AJ, SJW, PA, RP, and SN declare that they have no conflict of interest.

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Written informed consent was taken from all the subjects.

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The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Jhajharia, A., Wanjari, S.J., Ashdhir, P. et al. Role and safety of human thrombin injection for the treatment of bleeding gastric varices. Indian J Gastroenterol 37, 321–325 (2018). https://doi.org/10.1007/s12664-018-0877-2

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