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Evaluation of therapeutic effects and serious complications following endoscopic obliterative therapy with Histoacryl.

Sato T, Yamazaki K - Clin Exp Gastroenterol (2010)

Bottom Line: Additional treatment was successfully performed in all recurrent cases.The two patients with splenic infarction improved with conservative medical treatment.Nonetheless, careful attention must be paid to avoid potentially serious complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan.

ABSTRACT

Background and aims: Our aim was to evaluate the utility of endoscopic obliterative therapy with Histoacryl for gastric varices and to investigate the incidence of serious complications.

Methods: Endoscopic obliterative therapy with Histoacryl was performed on 129 gastric variceal patients. Sixty-five patients had cardiofornical varices, and 64 had fundal varices. Forty-five of 129 patients were emergency cases and the other 84 patients were prophylactic cases. Endoscopic therapy was performed under fluoroscopy using 70% Histoacryl (Histoacryl diluted with 5% Lipiodol).

Results: Endoscopic hemostasis of gastric varices was successful in 45/45 (100%) emergency cases. The recurrence rate of gastric varices was 17/120 (14.2%) among patients whose variceal eradication was achieved. Additional treatment was successfully performed in all recurrent cases. The incidence of serious complications was 4/129 (3.1%), including two cases of splenic infarction, one case of pulmonary embolism, and one case of an inflammatory tumor of pancreatic tail. The two patients with splenic infarction improved with conservative medical treatment. The patient with pulmonary embolism showed no respiratory symptoms, and died of liver failure. The patient with the pancreatic tumor, which was diagnosed as an inflammatory tumor, was treated surgically.

Conclusions: Endoscopic obliterative therapy with Histoacryl is a useful and relatively safe method for treatment of bleeding gastric varices. Nonetheless, careful attention must be paid to avoid potentially serious complications.

No MeSH data available.


Related in: MedlinePlus

A) Endoscopic image that reveals F3, Lg-cf varices with erosion. B) Image of endoscopic obliterative therapy under fluoroscopy using 70% Histoacryl in this patient.Abbreviations: GV, gastric varices; GRS, gastro-renal shunt.
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f2a-ceg-3-091: A) Endoscopic image that reveals F3, Lg-cf varices with erosion. B) Image of endoscopic obliterative therapy under fluoroscopy using 70% Histoacryl in this patient.Abbreviations: GV, gastric varices; GRS, gastro-renal shunt.

Mentions: Both patients (F3, Lg-cf varices, see Figure 2a) with splenic infarction experienced persistent pain in their left upper quadrant immediately after injection, and developed a fever of 38 °C within five hours. We performed obliterative therapy using 70% Histoacryl under fluoroscopy (three times with a 2.5 mL total volume of Histoacryl (Figure 2b) in one case, and two times with a 2.5 mL volume in the other case). CT demonstrated large infarctions (70% in one case, and 90% in the other case, see Figure 2c) in the spleen. During hospitalization, white cell and platelet counts rose to two to three times above normal levels within 14 days. Fever and abdominal pains subsided gradually to full recovery with only conservative medical treatment and antibiotics in these 2 cases.


Evaluation of therapeutic effects and serious complications following endoscopic obliterative therapy with Histoacryl.

Sato T, Yamazaki K - Clin Exp Gastroenterol (2010)

A) Endoscopic image that reveals F3, Lg-cf varices with erosion. B) Image of endoscopic obliterative therapy under fluoroscopy using 70% Histoacryl in this patient.Abbreviations: GV, gastric varices; GRS, gastro-renal shunt.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3108656&req=5

f2a-ceg-3-091: A) Endoscopic image that reveals F3, Lg-cf varices with erosion. B) Image of endoscopic obliterative therapy under fluoroscopy using 70% Histoacryl in this patient.Abbreviations: GV, gastric varices; GRS, gastro-renal shunt.
Mentions: Both patients (F3, Lg-cf varices, see Figure 2a) with splenic infarction experienced persistent pain in their left upper quadrant immediately after injection, and developed a fever of 38 °C within five hours. We performed obliterative therapy using 70% Histoacryl under fluoroscopy (three times with a 2.5 mL total volume of Histoacryl (Figure 2b) in one case, and two times with a 2.5 mL volume in the other case). CT demonstrated large infarctions (70% in one case, and 90% in the other case, see Figure 2c) in the spleen. During hospitalization, white cell and platelet counts rose to two to three times above normal levels within 14 days. Fever and abdominal pains subsided gradually to full recovery with only conservative medical treatment and antibiotics in these 2 cases.

Bottom Line: Additional treatment was successfully performed in all recurrent cases.The two patients with splenic infarction improved with conservative medical treatment.Nonetheless, careful attention must be paid to avoid potentially serious complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan.

ABSTRACT

Background and aims: Our aim was to evaluate the utility of endoscopic obliterative therapy with Histoacryl for gastric varices and to investigate the incidence of serious complications.

Methods: Endoscopic obliterative therapy with Histoacryl was performed on 129 gastric variceal patients. Sixty-five patients had cardiofornical varices, and 64 had fundal varices. Forty-five of 129 patients were emergency cases and the other 84 patients were prophylactic cases. Endoscopic therapy was performed under fluoroscopy using 70% Histoacryl (Histoacryl diluted with 5% Lipiodol).

Results: Endoscopic hemostasis of gastric varices was successful in 45/45 (100%) emergency cases. The recurrence rate of gastric varices was 17/120 (14.2%) among patients whose variceal eradication was achieved. Additional treatment was successfully performed in all recurrent cases. The incidence of serious complications was 4/129 (3.1%), including two cases of splenic infarction, one case of pulmonary embolism, and one case of an inflammatory tumor of pancreatic tail. The two patients with splenic infarction improved with conservative medical treatment. The patient with pulmonary embolism showed no respiratory symptoms, and died of liver failure. The patient with the pancreatic tumor, which was diagnosed as an inflammatory tumor, was treated surgically.

Conclusions: Endoscopic obliterative therapy with Histoacryl is a useful and relatively safe method for treatment of bleeding gastric varices. Nonetheless, careful attention must be paid to avoid potentially serious complications.

No MeSH data available.


Related in: MedlinePlus