Abstract
Gastric variceal hemorrhage is associated witha high morbidity and mortality. We report the efficacyand safety of bovine thrombin in the treatment ofbleeding gastric varices. At endoscopy 52 patients with hematemesis were diagnosed with bleedinggastric varices. Patients were treated by intravaricealinjection with bovine thrombin and underwent furtherendoscopy at 72 hr and then at two-week intervals. Initial hemostasis was achieved in 49/52patients (94%). Bleeding-related mortality at 72 hrafter the index bleed was 3/52 (6%). The mean amount ofthrombin used to achieve initial hemostasis was 1070 IU (range 400-2000 IU) and no adverse drugeffects were observed. The median number of treatmentsessions required to achieve gastric variceal ablationwas 2 (range 1-3). At six weeks, 9 of 49 surviving patients (18%) rebled and one further patientdied. The six-week mortality in patients treated withthrombin was 4/52 (8%). In conclusion, safe andeffective hemostasis of bleeding gastric varices can be achieved by intravariceal injection withthrombin.
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REFERENCES
Sarin S, Lahoti D, Saxena S, Murthy N, Makwanu U: Prevalence, classification and natural history of gastric varices: A long-term follow up study in 568 portal hypertension patients. Hepatology 16:1343-1349, 1992
Gimson A, We staby D, Williams R: Endoscopic sclerotherapy in the management of gastric variceal haemorrhage. J Hepatol 13(3):274-278, 1991
Julian R, Gooday R, O'Carroll R, Redhead D, Elton R, Hayes P: A prospective evaluation of changes in neuropsychological and liver function tests following transjugular intrahepatic portosystemic stent-shunt. J Hepatol 23(6):697-705, 1995
Malt R: Portosystemic venous shunts. N Engl J Med 295(24):80-82, 1976
Trudeau W, Prindiville T: Endoscopic injection sclerosis in bleeding gastric varices. Gastrointestinal Endosc 32:264-268, 1986
Ramond M, Valla D, Gotleb J: Obstruction endoscopique des varices oesogastriques par la bucrylite. Gastroenterol Clin Biol 10:575-578, 1986
Ohio K, Iwao T, Sumino M, Toyonaga A, Tanikuwa K: Ethanolamineoleate versus butyl cyanoacrylate for bleeding gastric varices: A nonrandomised study. Endoscopy 27(5):349-354, 1995
Vitte R, Eugene C, Fingerhut A, Felsenheld C, Merrer J: Fatal outcome following endoscopic fundal variceal ligation. Gastrointest Endosc 43(1):82, 1996
Jutabha R, Jensen D, Egan J. Mailicado G, Hirabayashi K: Randomised prospective study of cyanoacrylate injection, sclerotherapy or rubber band ligation for endoscopic haemostasis of bleeding canine gastric varices. Gastrointest Endosc 41(3):201-203, 1995
Jackson M, MacPhee M, Drohan W, Alving B: Fibrin sealant: current and potential clinical applications. Blood Coagul Fibrinol 7(8):737-746, 1996
Lebowitz R, Hoffman R, Roland J, Cohen N: Autologous fibrin glue in the prevention of cerbrospinal fluid leak following acoustic neuroma surgery. Am J Otol 16(2):172-174, 1995
Williams S, Peters R, Westaby D: Thrombin-an effective treatment for gastric variceal haemorrhage. Gut 1287-1289, 1994
Snobl J, van Buuren H, van Blankenstein M: Endoscopic injection therapy using thrombin: An effective and safe method for controlling esophagogastric variceal bleeding. Gastroenterology 102:A891, 1992
Rai R, Panzer S, Miskovsky E, Thuluvath P: Thrombin injection for bleeding duodenal varices. Am J Gastroenterol 89(10):1871-1873, 1994
Sans M, Llach J, Bordas J, Andreu V, Reverter J, Bosch J, Mondelo F, Salmeon J, Mas A, Teres J, Rhodes J: Thrombin and ethanolamine injection therapy in arresting bleding from duodenal varices. Endoscopy 28(4):403, 1996
Kim T, Shijo H, Kokawa H, Tokumitsu H, Kubara K, Ota K, Akiyoshi N, Iida T, Yokoyama M, Okumura M: Risk factors for hemorrhage from gastric fundal varices. Hepatology 25(2):307-312, 1997
Burroughs A, Mezzanote G, Phillips A, McCormick A, McIntyre N: Cirrhotics with variceal hemorrhage: The importance of the time interval between admission and the start of analysis for survival and re-bleeding rates. Hepatology 9(6):801-807, 1989
Sarin S, Sachdev G, Nanda R, Misra S, Broor S: Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg 75:747-750, 1988
Jensen D, Kovacs T, Randall G, et al: Emergency sclerothe rapy vs rubber band ligation for actively bleeding esophagogastric varices in a randomized prospective study. Gastroenterology 40A:244, 1994
Soehendra N, Grimm H, Nam V, Berger N: N-Butyl-2-cyanoacrylate: A supplement to endoscopic sclerotherapy. Endoscopy 19:221-224, 1987
Sanyal A, Freedman A, Lukehi V, Purdin P, Shiffman M, Tisnado J, Cole P: Transjugular intrahepatic porto-systemic shunts for patients with active variceal haemorrhage unresponsive to sclerotherapy. Gastroente rology 111(1):138-146, 1996
Speiss S, Matalon T, Jensen D, Rosenblate H, Brunner M, Ganger D: Transjugular intrahepatic portosystemic shunt in nonliver transplant candidates: Is it indicated? Am J Gastroenterol 90:1238-1243, 1995
Cosenza C, Hoffman A, Friedman M, Sher L, Lopez R, Van-Allen R, Brown D, Fraiman M, Arnaout W, Vierling J, Makowka L: Transjugular intrahepatic portosystemic shunt: Efficacy for the treatment of portal hypertension and impact on liver transplantation. Am Surg 62(10):835-839, 1996
Fugii Y, Sugawa C, Ozawa C: Haemostasis activation during esophageal variceal sclerotherapy with thrombin in cirrhotics. Am Surg 57:222-225, 1991
Rothenbey D, Moy J: Anaphylactic reaction to topical bovine thrombin. Anaesthesiology 78(4):779-782, 1993
Kubba A, Murphy W, Palmer K: Endoscopic injection for bleeding peptic ulcer: A comparison of adrenaline alone with adrenaline plus human thrombin. Gastroenterology 111(3):623-628, 1996
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Przemioslo, R.T., Mcnair, A. & Williams, R. Thrombin Is Effective in Arresting Bleeding from Gastric Variceal Hemorrhage. Dig Dis Sci 44, 778–781 (1999). https://doi.org/10.1023/A:1026626212129
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DOI: https://doi.org/10.1023/A:1026626212129