Diagnostic et traitement endoscopique des varices gastriques

Translated title of the contribution: Endoscopic diagnosis and treatment of gastric varices

G. Battaglia, T. Morbin, E. Patarnello, A. Carta, F. Coppa, A. Ancona

Research output: Contribution to journalArticlepeer-review

Abstract

The development of gastrooesophageal varices is directly related to the hypertension in the spleno-portal district. About 30 % of patients with liver cirrhosis develop oesophageal or gastric varices. The mortality of the first bleeding episode is still very high (30-40 %) and represents 13 % of the overall causes of death in these patients. An increasing interest in gastric varices, as far as incidence, frequency and relationship with oesophageal varices are concerned, has been developed in the last fifteen year. In consideration of the excellent results obtained with the sclerotherapy of oesophageal varices, there has also been a revaluation of this technique for the treatment of gastric varices, which formerly had been strictly surgical. In literature a large variety of sclerosing agents have been used, but there is evidence that the best results are obtained by using the technique suggested by Sohendra and Gottlib, which has been adopted by us. This implies the use of isobutyl-2-cyanoacrylate, a synthetic resin diluted in Lipiodol 50 %. In our experience of 68 patients who underwent sclerotherapy of the gastric varices, we obtained the control of active haemorrhage in 96.8 %. Early rebleeding occurred in 34.4 % of the patients. In only one case this was related to gastric varices bleeding, whereas in 3 cases the rebleeding was related to oesophageal varices, in 4 cases to an ulcer on the injection site and in 3 cases to other causes. The mortality rate of this group was 18.7 %. The efficacy of this technique has also been demonstrated in a group of patients treated prophylactically or with elective treatment. In fact, rebleeding occurred in 11.8 % and no patients died. In 62 patients we obtained long term survival, eradication of gastric varices was obtained in 42 patients (67.7 %); in 10 additional patients, the varices resulted obliterated whereas in 10 patients eradication could not be achieved. Long term mortality was satisfying, if we consider that 40 % of the patients were classified as Child-risk category >. After one year, survival rate was 72 %. Varices, after 5 years, 57 % and after 8 years 51 %. Of the 19 long-term deaths we recorded, 63 % were not related to gastro-oesophageal varices, this demonstrates that the hepatic disease influences mortality more heavily than haemorrhagic recurrences. These data confirm that at present, the endoscopic sclerotherapy with cyanoacrylate, both in emergency and in election, is a valid alternative to surgical therapy of the > gastric varices.

Translated title of the contributionEndoscopic diagnosis and treatment of gastric varices
Original languageFrench
Pages (from-to)97-114
Number of pages18
JournalActa Endoscopica
Volume29
Issue number2
Publication statusPublished - 1999

Keywords

  • Cyanoacrylates therapeutic use
  • Esophageal and gastric varices diagnosis
  • Esophageal and vastric varices
  • Sclerotherapy methods

ASJC Scopus subject areas

  • Medicine(all)

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