医学
碘化油
氰基丙烯酸酯
胃静脉曲张
外科
静脉曲张
不利影响
随机对照试验
门脉高压
内科学
栓塞
肝硬化
化学
胶粘剂
有机化学
图层(电子)
作者
Xiaoqing Zeng,Lili Ma,Yujen Tseng,Jie Chen,Chunxiao Cui,Tiancheng Luo,Jian Wang,Shiyao Chen
摘要
Abstract Background and Aim Current guidelines recommend injection of cyanoacrylate as first‐line therapy to prevent gastric variceal rebleeding. The method still poses a risk of ectopic embolism, which possibly correlates with the volume of cyanoacrylate used. In this trial, we evaluated the short‐term efficacy and safety of tissue adhesive injection combined with lauromacrogol for treating gastric varices. Methods Patients admitted to our hospital for variceal hemorrhage were enrolled and blindly randomized into two treatment groups: lauromacrogol group (lauromacrogol‐cyanoacrylate‐lauromacrogol) and lipiodol group (lipiodol‐cyanoacrylate‐lipiodol). Patient follow‐up was 6 months. Primary outcome was rebleeds, and secondary outcomes were mortality, gastric varices eradication, and treatment‐related adverse events. Results Between March 6, 2013 and October 16, 2013, 96 patients met the criteria. Two cases were lost to follow‐up, and all treated cases were successful. No procedural‐related adverse events were observed in either group. Cyanoacrylate volumes used in the lauromacrogol group were significantly less than those of the lipiodol group (0.9 ± 0.5 vs 2.0 ± 1.2 mL, P = 0.000). Eleven patients developed upper gastrointestinal rebleeding, which did not show significant difference between groups. On multivaritate analysis, portal venous thrombosis and fever were potential risk factors of rebleeding. Treatment failure, complications, gastric varices obturation, and survival did not differ between the two groups. Conclusion Tissue adhesives combined with lauromacrogol is a safe therapeutic option for gastric varices, with comparably less cyanoacrylate volume used. Because of the small number of study patients, it cannot be proven to have better efficacy than without lauromacrogol. Multicenter studies with larger patient groups are necessary.
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