Endoscopic histoacryl injection combined with ligation in the treatment of severe esophageal and gastric varices

doi:10.3969/j.issn.2095-4344.2015.12.017

Abstract

Abstract:

BACKGROUND: As a commonly used tissue adhesive in China, histoacryl can produce transient polymerization and rapidly solidify biological tissue, and it has good prospect in treatment of esophageal and gastric varicose bleeding.
OBJECTIVE: To explore the short- and long-term clinical efficacy of endoscopic histoacryl injection combined with ligation for the treatment of esophageal and gastric varices.
METHODS: Ninety patients with esophageal and gastric varices were treated by endoscopic adhesive injection and dense ligation. There were 64 males and 26 females, aged 22-75 years. At 2-4 weeks post-treatment, patients were re-checked under an endoscope. The short-term efficacy and adverse reactions, such as the hemostasis rate, varicose vein, varicose vein diameter, red color sign and portal hypertension gastropathy were observed. All patients were followed up for 3-39 months after varicose vein was eradicated, to monitor the middle- and long-term clinical efficacy, including varicose vein, tissue adhesive discharging and local proliferation, rebleeding, recurrence and complications.
RESULTS AND CONCLUSION: (1) Short-term efficacy: The number of varicose veins significantly reduced, red color signs reduced, and portal hypertension gastropathy improved (P < 0.01), but three cases appeared early rebleeding. The adhesives began to discharge from 2 weeks to 3 months post-treatment, no case appeared esophageal stenosis, perforation, severe infection, heterotopic embolism and other injection-related complication. (2) Middle- and long-term efficacy: varicose vein recurred in nine cases and five cases developed long-term rebleeding. Experimental findings indicate that, endoscopic histoacryl injection combined with ligation is effective to treat severe esophageal varices or (and) bleeding, with high success rate and good hemostasis effect, and it also prevents long-term rebleeding and recurrence.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Tissue Adhesives, Esophageal and Gastric Varices, Natural Orifice Endoscopic Surgery

CLC Number:

R318

Cai Jin-wei, Zhou Ying-sheng. Endoscopic histoacryl injection combined with ligation in the treatment of severe esophageal and gastric varices[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(12): 1894-1898.

Figures/Tables 3

References

[1] 洪军波,吕农华,汪安江,等.食管胃静脉曲张早期再出血的危险因素分析[J].中华消化杂志,2011,30(11): 836-837.
[2] Cordon JP,Torres CF,García AB,et al.Endoscopic management of esophageal varices.World J Gastrointest Endosc.2012;4(7):312.
[3] 陈世耀,马丽黎.内镜下注射组织黏合剂治疗胃静脉曲张[J].中华胃肠外科杂志,2012, 15(7): 654-655.
[4] 程留芳,贾继东,徐小元,等.肝硬化门静脉高压食管胃静脉曲张出血的防治共识(2008, 杭州)[J].中华保健医学杂志,2008,10(4): 241-248.
[5] 李因茵,苏艳,安林静,等.内镜下组织黏合剂治疗急性食管胃底静脉曲张出血的护理[J]. 护理学报,2011,18(2):45-46.
[6] 万晓强,郑紫丹,杨杰.内镜套扎治疗 50 例肝硬化食管静脉曲张破裂出血的临床观察 [J].重庆医学,2012,41(3):311-312.
[7] 周年兰,张明娟,王甦,等.内镜下套扎硬化剂及组织胶注射治疗食管静脉曲张破裂出血的近期疗效观察[J].临床肝胆病杂志,2014, 30(7):628-630.
[8] Ikeda F,Okamoto R,Baba N,et al.Prevalence and associated factors with esophageal varices in early primary biliary cirrhosis. J Gastroenterol Hepatol.2012;27(8):1320-1328.
[9] Montes Ramirez ML,Pascual-Pareja JF,Sánchez-Conde M,et al.Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis.AIDS.2012;26(14): 1807-1812.
[10] Ye XP,Ran HT,Cheng J,et al.Liver and spleen stiffness measured by acoustic radiation force impulse elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B. J Ultrasound Med. 2012; 31(8):1245-1253.
[11] 蔡莉,文黎明.国产组织胶内镜下注射联合套扎治疗食管胃底静脉曲张的临床应用[J].西南军医,2012,12(8):866-867.
[12] 何顺辉,邓毅斯,杜国平.组织胶注射联合套扎术治疗肝硬化食管胃底静脉曲张的疗效分析[J].中国医药科学,2011,1(23):71-72.
[13] 宋建忠,高占峰,苏秉忠,等.内镜套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血疗效观察[J].临床和实验医学杂志,2013, 12(6):429-430.
[14] Cordon JP,Torres CF,García AB,et al.Endoscopic management of esophageal varices.World J Gastrointest Endosc.2012;4(7):312.
[15] Sarin SK,Lamba GS,Kumar M,et al.Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding.N Engl J Med.1999;340(13):988-993.
[16] Karadsheh Z,Allison H.Primary Prevention of Variceal Bleeding:Pharmacological Therapy Versus Endoscopic Banding. N Am J Med Sci.2013;5(10): 573-579.
[17] 范合璋.内镜下两种套扎法治疗食管静脉重度曲张疗效观察[J].华西医学,2014, 29(2):246-248.
[18] Suga T,Akamatsu T,et al.Actual behaviour of N-bu-tyl-2- cyanoacrylate (histoacry1) in a blood vessel: a model of the varix. Endoscopy.2002;34(1):73-77.
[19] Cheng LF,Wang ZQ,Li CZ,et al.Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate. Clin Gastroenterol Hepatol. 2010;8(9):760-766.
[20] 王进广,孔德润.内镜干预及联合普萘洛尔预防食管静脉曲张破裂再出血的疗效[J].世界华人消化杂志,2012,20(30):2944-2950.