Abstract
Despite the recognized efficacy of elastic band ligation for the treatment of variceal bleeding, the results of endoscopic treatment in Child-Pugh C patients remain poor. A recent randomized controlled trial (RCT) proved that the early use of TIPS was related to less rebleeding rate and higher survival rate in decompensated (Child-Pugh scores from 9-13 points) cirrhotic patients (Garcia-Pagán et al,NEJM 2010:362:25). Ten years ago our group postulated that Child-Pugh C patients with variceal bleeding could benefit from glue injection. In a RCT involving 36 pts we proved the superiority of the endoscopic injection of glue (N-2-Butyl-Cyanoacrylate) for the bleeding control in Child-Pugh C pts compared to conventional sclerotherapy (Maluf-Filho et al.,Endoscopy 2001;33:421). We recognize that RCTs create an artificial environment which might overestimate the results of the intervention group. For the last ten years we have been treating Child-Pugh C pts by the endoscopic injection of cyanoacrylate for the control of variceal bleeding and we wanted to reassess the efficacy of the this treatment in that group of patients.
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