Experiencia del programa de aplicación de cianoacrilato en pacientes con varices gástricas del Hospital General de México

Abstract

IntroductionVariceal bleeding causes 10%-30% of upper gastrointestinal bleeding cases and gastric varices develop in 10%-30% of patients with portal hypertension. Although gastric varices bleed less frequently than oesophageal varices, when this occurs, it is associated with a 45% mortality rate. Obstructive methods using with tissue adhesives are the treatment of choice for gastric varices. ObjectivesTo determine the efficacy and safety of cyanoacrylate injection in gastric varices and its impact on survival. Material and MethodsThis was a retrospective analysis of patients with gastric varices treated with cyanoacrylate injection between January 2005 and May 2013 at the Endoscopy Unit of Hospital General de Mexico. ResultsA total of 333 patients were included, with male predominance (55%) and a mean age of 53.44±14.9 years. Alcohol was the most common cause of cirrhosis (46.5%), followed by chronic viral hepatitis (24.6%) and cryptogenic (28.8%). The Child-Pugh grade was A in 66 patients (19.81%), B in 126 (37.83%) and C in 141 (42.34%). The mean cyanoacrylate sessions until eradication were 1.83±0.574, with a mean 2.07±0.703 cyanoacrylate doses per session. Complications observed included splenic vein thrombosis (0.3%) and pleuritis (0.3%). Both were managed conservatively. Variceal eradication was achieved in 309 patients (92.8%). The survival rate was high, with 281 patients remaining alive (84.4%). Causes of death were associated to liver failure (6.3%) and infections (2.1%). No cases of mortality associated to bleeding were recorded. ConclusionsInjection of cyanoacrylate in gastric varices is a safe and effective procedure with a high eradication rate and a low complication/mortality rate.