N-BUTYL-2-CYANOACRYLATE (HISTOACRYL) PLUS SCLEROTHERAPY VERSUS SCLEROTHERAPY ALONE IN THE TREATMENT OF BLEEDING ESOPHAGEAL-VARICES - A RANDOMIZED PROSPECTIVE-STUDY

Background and Study Aims: N-2-cyanoacrylate (Histoacryl) and endoscop ic sclerotherapy with polidocanol have both been reported to control v ariceal bleeding, The aim of the present study was to compare the effe ctiveness of the combination of Histoacryl and endoscopic sclerotherap y with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates. Patients and Methods: One hu ndred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polid ocanol, acid 59 patients (Group B) were treated with conventional scle rotherapy with polidocanol alone, Histoacryl was injected intravaricea lly during the first session in the Group A patients. Results: A signi ficantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Gro up A: 2 of 20, Group B: 8 of 18, p < 0.05), The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B : 9 of 18, p < 0.05). Conclusions: The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophagea l bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management.