Objective To compare the efficacy and safety of titanium clip combined with tissue adhesive α-n-butyl-cyanoacrylate and α-n-butyl-cyanoacrylate alone in the treatment of isolated gastric variceal bleeding.
Methods Data of 96 patients admitted to the First Affiliated Hospital of Anhui Medical University, Infectious Diseases Hospital of Handan City and Beijing Ditan Hospital from March 2015 to April 2017 were collected retrospectively. According to the treatment, 46 patients in the group 1 were treated with titanium clamp before the injection of α-n-butyl-cyanoacrylate, 50 patients in the group 2 were treated with α-n-butyl-cyanoacrylate only intravascularly. CTA was performed before treatment to evaluate whether gastro-renal shunt(GRS) existed. The baseline data and treatment effect of the two groups were compared. The data were analyzed by SPSS 16.0 statistical software.
Results GRS was found in 59 patients among 66 patients. There was no significant difference in baseline data between the two groups. All patients achieved successful hemostasis under primary endoscopy. The dose of α-n-butyl-cyanoacrylate was(3.39±1.20) mL in group 1 and(2.53±1.05) mL in group 2(
P=0.031). The incidence of rebleeding was 4.35% in group 1 and 18.00% in group 2(
P=0.036). The disappearance rate of varicose veins was 100.00% in group 1 and 72.00% in group 2(
P=0.001). The incidence of complications, fever, abdominal pain, spontaneous bacterial peritonitis, ulcer after treatment, hepatic encephalopathy, ectopic embolism and death in the two groups was not statistically significant, but one case of cerebral embolism occurred in group 2.
Conclusion Endoscopic titanium clip clamping of varicose veins may be safer and more effective for treatment of isolated gastric varices bleeding before tissue adhesive injection.
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