Abstract
Background and study aims Bleeding from isolated gastric varices type I (IGV1) is more dangerous and fatal
than other types of esophageal variceal hemorrhages. However, optimum treatment for
bleeding from IGV1 remains undefined. This retrospective study compared the efficacy
of endoscopic clipping prior to N-butyl-2-cyanoacrylate injection (GVO) and only GVO
for treatment of IGV1.
Patients and methods Data were collected retrospectively at three medical centers. Ninety-six patients
were enrolled between March 2015 and April 2017 and divided into two groups: group
I (patients with endoscopic clipping prior to GVO, n = 46) and group II (patients
with only GVO, n = 50). Computed tomography angiography (CTA) was performed to evaluate
the status of gastrorenal shunts (GRS).
Results GRS was found in 59 of 66 patients (59/66). The groups did not differ in baseline
characteristics. Initial hemostasis was successfully achieved in all patients. There
was a significant difference in volume of N-butyl-2-cyanoacrylate administered (3.39 ± 1.20 mL
in group I versus 2.53 ± 1.05 mL in group II (P = 0.03). Rebleeding occurred in 4.35% of patients in group I and 18.00 % in group
II (P = 0.007). Variceal obliteration was achieved in all patients in group I and 72 %
in group II (P < 0.001) with only one session. Rate of complications was similar in both the groups
with the exception of one patient in group II who developed ectopic cerebral embolism.
Conclusions Endoscopic clipping prior to GVO may be an appropriate alternative to GVO as a treatment
modality for IGV1 bleeding.
