BACKGROUND: No single effective method has yet been established for the primary prophylaxis of bleeding from gastric varices (GV). METHODS: We retrospectively analyzed liver cirrhosis patients with GV who had undergone either endoscopic variceal obturation (EVO) or balloon-occluded retrograde transvenous obliteration (BRTO) as prophylactic treatments, comparing them with those who were observed without any procedural intervention. The endpoints were GV bleeding rate and complete eradication rate. RESULTS: 72 patients in EVO, 41 patients in BRTO, and 97 patients in the clinical observation groups were enrolled. No difference was observed in baseline characteristics. As the primary endpoint, 14 (19.4%) patients in the EVO group and 3 (7.3%) in the BRTO group bled from GV after prophylactic treatment, and 34 (35.1%) patients bled in the observation group during the median follow-up of 35 months (p = 0.001). Patients who received EVO or BRTO developed less bleeding from GV than those who received observation only, with no difference between EVO and BRTO (EVO vs. observation, p = 0.038; BRTO vs. observation, p = 0.001; EVO vs. BRTO, p = 0.089). As secondary endpoints, GV disappeared completely in 33 patients (45.8%) in the EVO group and 31 patients (75.6%) in the BRTO group (p = 0.003). By multivariate analysis, complete eradication of GV was the sole determinant for predicting GV bleeding. CONCLUSIONS: EVO and BRTO are effective and safe primary prophylactic treatments for preventing bleeding from GV. In particular, BRTO is better than EVO in complete eradication of GV.
BACKGROUND: No single effective method has yet been established for the primary prophylaxis of bleeding from gastric varices (GV). METHODS: We retrospectively analyzed liver cirrhosispatients with GV who had undergone either endoscopic variceal obturation (EVO) or balloon-occluded retrograde transvenous obliteration (BRTO) as prophylactic treatments, comparing them with those who were observed without any procedural intervention. The endpoints were GV bleeding rate and complete eradication rate. RESULTS: 72 patients in EVO, 41 patients in BRTO, and 97 patients in the clinical observation groups were enrolled. No difference was observed in baseline characteristics. As the primary endpoint, 14 (19.4%) patients in the EVO group and 3 (7.3%) in the BRTO group bled from GV after prophylactic treatment, and 34 (35.1%) patients bled in the observation group during the median follow-up of 35 months (p = 0.001). Patients who received EVO or BRTO developed less bleeding from GV than those who received observation only, with no difference between EVO and BRTO (EVO vs. observation, p = 0.038; BRTO vs. observation, p = 0.001; EVO vs. BRTO, p = 0.089). As secondary endpoints, GV disappeared completely in 33 patients (45.8%) in the EVO group and 31 patients (75.6%) in the BRTO group (p = 0.003). By multivariate analysis, complete eradication of GV was the sole determinant for predicting GV bleeding. CONCLUSIONS:EVO and BRTO are effective and safe primary prophylactic treatments for preventing bleeding from GV. In particular, BRTO is better than EVO in complete eradication of GV.
Authors: H Iwase; O Maeda; M Shimada; T Tsuzuki; R M Peek; Y Nishio; T Ando; K Ina; K Kusugami Journal: Gastrointest Endosc Date: 2001-05 Impact factor: 9.427
Authors: T Kim; H Shijo; H Kokawa; H Tokumitsu; K Kubara; K Ota; N Akiyoshi; T Iida; M Yokoyama; M Okumura Journal: Hepatology Date: 1997-02 Impact factor: 17.425
Authors: Gwang Ho Baik; Dong Joon Kim; Ho Gwon Lee; Seul Ki Min; Seung Jin Kong; Jin Bong Kim; Ja Young Lee; Tae Ho Hahn; Il Hyun Baek; Jong Hyeok Kim; Bong Soo Kim; Woo Cheol Hwang Journal: Korean J Gastroenterol Date: 2004-03