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A PROSPECTIVE, SINGLE-CENTER, RANDOMIZED, OPEN-LABEL STUDY TO INVESTIGATE EFFICACY AND LONG-TERM OUTCOME OF CYANOACRYLATE GLUE FOR ALL GASTRIC VARICES (GOV1, GOV2, IGV1, IGV2) VERSUS ITS USE ONLY GOV 2 AND IGV 1 GASTRIC VARICES WITH STIGMA OF RECENT HAEMO

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A PROSPECTIVE, SINGLE-CENTER, RANDOMIZED, OPEN-LABEL STUDY TO INVESTIGATE EFFICACY AND LONG-TERM OUTCOME OF CYANOACRYLATE GLUE FOR ALL GASTRIC VARICES (GOV1, GOV2, IGV1, IGV2) VERSUS ITS USE ONLY GOV 2 AND IGV 1 GASTRIC VARICES WITH STIGMA OF RECENT HAEMO

Pankaj Desai 1, Chintan Patel 1, Mayank V Kabrawala 1, Ritesh Prajapati 1, Rinkalben Kakadiya 1, Mohit Sethia 1, Nisharg Patel 1

Affiliations

1 SIDS Hospital & Research Centre, Surat, India

Summary

AI Generated

In cirrhotic patients with first variceal bleed and large gastric varices, aggressive cyanoacrylate injection of all visible gastric varices achieved faster obliteration but showed no difference in rebleeding, mortality, or decompensation compared to conservative therapy targeting only high-risk varices at one year.

Rebleeding rates at one year were similar between aggressive cyanoacrylate treatment of all visible gastric varices (Group A, n=66) and conservative treatment targeting only varices with stigmata of recent hemorrhage or high-risk features (Group B, n=68), with no significant difference (p=0.639).
One-year all-cause mortality and mortality due to variceal rebleed were comparable between the two groups (p=0.261 for rebleed mortality).
Aggressive treatment required significantly fewer sessions for gastric variceal obliteration (mean 1.24 ± 0.69 sessions vs 2.49 ± 1.38 sessions, p=0.01).
Decompensation rates at one year, including new or worsening ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy, were similar in both groups.
Adverse events did not differ significantly between aggressive and conservative strategies.
The presenter suggested that focusing on high-risk varices may offer an effective alternative to aggressive treatment without compromising long-term outcomes, provided complete obliteration is achieved and patients adhere to beta blockers.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

There is significant interpersonal variation in management of gastric varices. In real life scenario both large esophageal and gastric varices coexist in a significant number of cases. In patients presenting with variceal bleed, source of bleed whether esophageal or gastric varices is not clear in most patients. How aggressively to manage the large gastric varices in patients who had variceal bleed is not defined. The aim of this study was to compare aggressive management of gastric varices with conservative management of gastric varices in patient with variceal bleed.

Aims & Methods

Consecutive patients with cirrhosis presenting with 1^st episode of variceal bleed and having large gastric varices (Gastroesophageal varices (GOV)1, GOV2, Isolated gastric varices (IGV) 1) were randomized to receive aggressive (Group A, n=66) or conservative therapy (Group B, n=68) for gastric varices. Aggressive group received glue injection for all types of gastric varies followed by band ligation of the oesophageal varies. While group B patients were treated primarily with band ligation for oesophageal and GOV 1 varies and glue was used only those IGV or GOV 2 varies which revealed stigma of recent haemorrhage ( SRH) (Table 1). Primary outcomes were variceal rebleed, rate of obliteration of varices or death at 1 year follow up.
Table 1: Endoscopic management on index and follow up endoscopy

Group A	Group B
Index endoscopy procedure
Endoscopic cyanoacrylate (CYA) injection for all visible GOV1, GOV2 and IGV1, and EVL for esophageal varices	EVL for esophageal varices, GOV1 with SRH Endoscopic cyanoacrylate injection for GOV2, IGV1 with SRH or High risk* GOV 2, IGV1 with no SRH
Follow up endoscopy procedure
Endoscopic cyanoacrylate (CYA) injection for all visible GOV1, GOV2 and IGV1, and EVL for esophageal varices	EVL for esophageal varices, GOV1 with SRH Endoscopic cyanoacrylate injection for GOV2, IGV1 with SRH

*High risk: size of varix (> 10mm) & red wale marks
Abbreviations: SRH, stigmata of recent haemorrhage; EVL, Endoscopic variceal ligation; GOV, gastroesophageal varices; IGV, Isolated gastric varices.

Results

There was no difference in the number of rebleed events among groups at 1 year (p=0.639).
Mortality due to variceal rebleed was comparable in both groups at 1 year (p=0.261), 6 months and 1 month. 1-year all-cause mortality was comparable in both groups.
The mean number of sessions required for obliteration of varices was lower in Group A than in Group B (1.24 ± 0.69 and 2.49 ± 1.38 respectively, p=0.01).
There was no significant difference between the two groups regarding the adverse events.

Conclusion

Aggressive approach to management of gastric varices using cyanoacrylate glue leads to early obliteration of varices but has similar rebleeding rates and survival benefit as compared to a more conservative approach.

Event

UEG Week Vienna 2024

Topics

Endoscopy Small Intestine & Nutrition Stomach & H. Pylori Oesophagus

Submission format

Abstract

Session

Upper GI bleeding: Treatment and outcome

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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