Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding

A 10-year experience

Tomohiko Akahoshi, Makoto Hashizume, Rinshyun Shimabukuro, Kazuo Tanoue, Morimasa Tomikawa, Keishi Okita, Norikazu Gotoh, Kouzou Konishi, Norifumi Tsutsumi, Keizo Sugimachi

Research output: Contribution to journalArticle

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Abstract

Backgroud. The long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) were evaluated as the initial treatment for bleeding gastric varices. Patients and Methods. Fifty-two patients with bleeding gastric varices underwent endoscopic injections of Histoacryl for hemostasis over a 1O-year period. Histoacryl was injected intravariceally. Among these 52 patients, 32 had active bleeding and 20 had recent bleeding. Most of the varices were large (F2 or F3, 48 cases). After Histoacryl injection, the patients were followed endoscopically with retreatment administered as necessary. The patients were followed for a mean 28.1 months. Results. The rate of initial hemostasis (no bleeding occurred for 48 hours after sclerotherapy) was 96.2%. Cumulative nonbleeding rates were 64.7%, 52.7%, and 48.2% at 1, 5, and 10 years, respectively. When rebleeding occurred, 80.0% was within 1 year after initial injection. Recurrent bleeding was easily stopped with the reinjection of Histoacryl in most patients. The treatment failure-related mortality rate was 4.0% (2 of 52). The cumulative survival rates were 66.9%, 60.4%, and 55.5% at 1, 5, and 10 years, respectively. The mortality depended on either malignancy or liver function (Child-Pugh classification). Conclusions. These results suggest that Histoacryl injection sclerotherapy is highly effective for the treatment of bleeding gastric varices, with rare complications occurring both acutely and long-term. Therefore, Histoacryl injection sclerotherapy is considered to be the first choice of treatment for bleeding gastric varices, but the rate of recurrent bleeding is so high that further methods or devices still need to be developed in order to prevent gastric variceal rebleeding.

Original languageEnglish
Pages (from-to)S176-S181
JournalSurgery
Volume131
Issue number1
DOIs
Publication statusPublished - Jan 1 2002

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Enbucrilate
Sclerotherapy
antineoplaston A10
Stomach
Hemorrhage
Injections
Esophageal and Gastric Varices
Hemostasis
Retreatment
Mortality
Varicose Veins
Treatment Failure
Therapeutics
Survival Rate
Safety

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Akahoshi, T., Hashizume, M., Shimabukuro, R., Tanoue, K., Tomikawa, M., Okita, K., ... Sugimachi, K. (2002). Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: A 10-year experience. Surgery, 131(1), S176-S181. https://doi.org/10.1067/msy.2002.119501

Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding : A 10-year experience. / Akahoshi, Tomohiko; Hashizume, Makoto; Shimabukuro, Rinshyun; Tanoue, Kazuo; Tomikawa, Morimasa; Okita, Keishi; Gotoh, Norikazu; Konishi, Kouzou; Tsutsumi, Norifumi; Sugimachi, Keizo.

In: Surgery, Vol. 131, No. 1, 01.01.2002, p. S176-S181.

Research output: Contribution to journalArticle

Akahoshi, T, Hashizume, M, Shimabukuro, R, Tanoue, K, Tomikawa, M, Okita, K, Gotoh, N, Konishi, K, Tsutsumi, N & Sugimachi, K 2002, 'Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: A 10-year experience', Surgery, vol. 131, no. 1, pp. S176-S181. https://doi.org/10.1067/msy.2002.119501
Akahoshi, Tomohiko ; Hashizume, Makoto ; Shimabukuro, Rinshyun ; Tanoue, Kazuo ; Tomikawa, Morimasa ; Okita, Keishi ; Gotoh, Norikazu ; Konishi, Kouzou ; Tsutsumi, Norifumi ; Sugimachi, Keizo. / Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding : A 10-year experience. In: Surgery. 2002 ; Vol. 131, No. 1. pp. S176-S181.
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abstract = "Backgroud. The long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) were evaluated as the initial treatment for bleeding gastric varices. Patients and Methods. Fifty-two patients with bleeding gastric varices underwent endoscopic injections of Histoacryl for hemostasis over a 1O-year period. Histoacryl was injected intravariceally. Among these 52 patients, 32 had active bleeding and 20 had recent bleeding. Most of the varices were large (F2 or F3, 48 cases). After Histoacryl injection, the patients were followed endoscopically with retreatment administered as necessary. The patients were followed for a mean 28.1 months. Results. The rate of initial hemostasis (no bleeding occurred for 48 hours after sclerotherapy) was 96.2{\%}. Cumulative nonbleeding rates were 64.7{\%}, 52.7{\%}, and 48.2{\%} at 1, 5, and 10 years, respectively. When rebleeding occurred, 80.0{\%} was within 1 year after initial injection. Recurrent bleeding was easily stopped with the reinjection of Histoacryl in most patients. The treatment failure-related mortality rate was 4.0{\%} (2 of 52). The cumulative survival rates were 66.9{\%}, 60.4{\%}, and 55.5{\%} at 1, 5, and 10 years, respectively. The mortality depended on either malignancy or liver function (Child-Pugh classification). Conclusions. These results suggest that Histoacryl injection sclerotherapy is highly effective for the treatment of bleeding gastric varices, with rare complications occurring both acutely and long-term. Therefore, Histoacryl injection sclerotherapy is considered to be the first choice of treatment for bleeding gastric varices, but the rate of recurrent bleeding is so high that further methods or devices still need to be developed in order to prevent gastric variceal rebleeding.",
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