Endoscopy 2021; 53(02): 210
DOI: 10.1055/a-1233-8902
Letter to the editor

Thrombin or glue – you decide

Gaurav Kumar Singh
1  Department of Gastroenterology, Lokmanya Tikal Municipal Medical College and General Hospital, Mumbai, India
,
Shamshersingh G. Chauhan
1  Department of Gastroenterology, Lokmanya Tikal Municipal Medical College and General Hospital, Mumbai, India
,
Pratik Sethiya
1  Department of Gastroenterology, Lokmanya Tikal Municipal Medical College and General Hospital, Mumbai, India
,
Vikas Pandey
1  Department of Gastroenterology, Lokmanya Tikal Municipal Medical College and General Hospital, Mumbai, India
› Author Affiliations

We recently read with great interest an article by Gin-Ho Lo and co-workers entitled “A prospective, randomized trial of thrombin versus cyanoacrylate injection in the control of acute gastric variceal hemorrhage,” which was published in the July 2020 edition of this journal [1]. The authors studied the efficacy of thrombin and cyanoacrylate injection in controlling acute gastric variceal bleeding. They concluded that endoscopic thrombin injection is as efficacious as glue in achieving hemostasis and was shown to be safe, with fewer complications. However, a few concerns remain that need some discussion.

First, in the aforementioned study, gastroesophageal varices type 1 (GOV1) were included in both of the study groups: 15 out of 33 patients who received thrombin and 17 of 35 patients who received glue injection. However, the usual management of GOV1 is variceal band ligation, according to the studies of Sarin [2] and the Baveno VI group [3].

Second, there is no mention of the size of the gastric varices in each group, but size is related to severity of bleeding, as suggested by the study of Zeeshan et al. [4], or of the experience of the endoscopists, and whether the same endoscopists were employed or not is unclear. Because glue injection of gastric varices requires technical skills, subjective error on the part of the operator is a likely scenario [5].

Despite these questions, we really appreciate the efforts of the author and his team, as this study has indeed made thrombin an option for management in the coming years. We suggest that a similar study with higher sample size and similar cohorts in both groups would lead to a better comparison in future.



Publication History

Publication Date:
27 January 2021 (online)

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