Abstract
Background and Study Aims: Information about the appropriate endoscopic treatment of gastric variceal bleeding
is sparse. We therefore designed a prospective and randomized study to evaluate and
compare efficacy and complication rates of two agents, hypertonic glucose water (50 %
GW) and sodium tetradecyl sulfate (STS), in treating acute gastric variceal bleeding
after esophageal varix eradication.
Patients and Methods: Of 51 patients with advanced cirrhosis of the liver (Child's C), with acute gastric
variceal bleeding initially evaluated, 25 patients were randomized to receive 1.5 %
STS and 26 to receive 50 % glucose water. Treatment was aimed at achieving initial
and permanent hemostasis by variceal eradication.
Results: Control of acute gastric variceal bleeding was achieved in 80 % of the STS group
and 92 % of the GW group. The rebleeding rate in the STS group was 70 %, while in
the GW group it was 30 % (P < 0.05). Overall, obliteration was achieved in only 32 %
of the STS group and 81 % of the GW group during admission (P < 0.05). There was a
trend toward a higher gastric ulcer rate in the STS group compared with the GW group
(92 % vs. 30 %; P < 0.05). The rebleeding control rate and permanent hemostasis rate
in the GW group (70 %, 54 %) were also significantly higher than in the STS group
(21 %, 12 %; P < 0.05; P < 0.05). The hospital mortality for the STS group was 50 %,
and for the GW group 30 %.
Conclusion: Treatment with hypertonic glucose water in gastric vericeal bleeding was superior
to treatment with STS in controlling bleeding and in achieving vericeal obliteration,
less rebleeding, and a lower complication rate. The results of this study suggest
that hypertonic glucose water is a clinically effective, easily available, and safe
sclerosing agent.
