Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience,☆☆,

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Abstract

Background: Bleeding from gastric varices is often a serious medical emergency. The role of endoscopy in the management of gastric variceal bleeding is still controversial. The types of gastric varices and their respective management strategies have not been identified. Methods: Gastric varices were observed in 209 patients with portal hypertension. Seventy-one patients (with cirrhosis 33, noncirrhotic 38) underwent gastric variceal sclerotherapy, 53 of these (75%) for gastric variceal bleeding. By use of a previously described classification, gastric varices were divided into gastroesophageal varices, type 1 (GOV1) and type 2 (GOV2), and isolated gastric varices, type 1 (IGV 1). Gastric variceal sclerotherapy was done every week using a combination technique of paravariceal and intravariceal injections with absolute alcohol. Results: Emergency gastric variceal sclerotherapy arrested acute bleeding in 12 (66.7%) of 18 patients. Variceal obliteration was achieved in 43 of the 60 (71.6%) patients who underwent repeated elective sclerotherapy. Variceal obliteration was higher in patients with GOV1 (94.4%) than in those with GOV2 (70.4%) and IGV1 (41%). Rebleeding after elective gastric variceal sclerotherapy was seen in 5.5%, 19%, and 53%, respectively, in the three types of gastric varices. Gastric variceal recurrence was not seen during a mean follow-up of 24.2 ± 22.9 months. Seventeen (24%) patients died, nearly equally from rebleeding and liver failure. Conclusions: (1) Sclerotherapy can effectively arrest acute gastric variceal bleeding and achieve gastric variceal obliteration, (2) it is more effective in patients with gastroesophageal varices, and (3) alternative therapies need to be evaluated for patients with IGV1.(Gastrointest Endosc 1997;46:8-14)

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Patients and Methods

Patients who met the specific criteria underwent gastric variceal sclerotherapy. Inclusion criteria—two groups of patients were included: (1) patients with active gastric variceal bleeding or a past history of gastric variceal bleeding, or (2) patients with lesser curve varices (GOV1) that persisted for more than 6 months after esophageal variceal obliteration, i.e., prophylactic gastric variceal sclerotherapy. Exclusion criteria—all patients received gastric variceal sclerotherapy unless they

Results

Results of gastric variceal sclerotherapy in patients with different types of gastric varices are analyzed separately. Fifty-three of the 71 (74.6%) patients had a history of gastric variceal bleed. Eighteen patients, all belonging to the GOV1 category, underwent prophylactic gastric variceal sclerotherapy.

Discussion

This is probably the first study on the long-term results of gastric variceal sclerotherapy. The results clearly show that sclerotherapy is a useful technique for the control of acute gastric variceal bleeding. It was also found to be quite effective in achieving gastric variceal obliteration. Unlike esophageal varices, recurrence of gastric varices after the initial obliteration was not seen during a mean follow-up of more than 2 years (Table 4).

Active gastric variceal bleeding could be

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From the Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.

☆☆

Reprint requests: S.K. Sarin, MD, DM, Gastroenterology, G.B. Pant Hospital, New Delhi 110 002, India.

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