Prospective, Randomized Trial of Hypertonic Glucose Water and Sodium Tetradecyl Sulfate for Gastric Variceal Bleeding in Patients with Advanced Liver Cirrhosis

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.