THE VALUE OF COMBINED USE OF N-BUTYL-2-CYANOACRYLATE AND ETHANOLAMINEOLEATE IN THE MANAGEMENT OF BLEEDING ESOPHAGOGASTRIC VARICES

Background and Study Aims: Recently, tissue adhesive material has been used to improve the initial control of bleeding from huge esophagogas tric varices, and to prevent them from rebleeding, in contrast to the conventional sclerotherapy, The present study assessed the value of th e combined use of the tissue adhesive substance: N-butyl-2-cyanoacryla te and ethanolamine oleate 5% for management of bleeding esophagogastr ic varices. Patients and Methods: One hundred and fourteen patients wi th documented active variceal bleeding at the time of endoscopy were a lternatively randomized into two groups. The combined therapy group in cluded 58 patients who underwent injection using both cyanoacrylate fo r large esophageal and gastric varices and a sclerosant agent for rema ining varices. The sclerosis, or control, group included 56 patients, who underwent injection with ethanolamine oleate. Results: This study proved the value of the combined therapy for the initial control of al l bleeders (the follow-up period ranged from 12 to 32 months). In the sclerosis group, failure of the initial control of bleeding was report ed in two cases (3.6%). Recurrent bleeding occurred in 8.6% in the com bined therapy group compared to 25% in the sclerosis group (p < 0.01). Two months of therapy was required to achieve complete eradication of varices in 56.5% and 21.4% in the combined therapy and the sclerosis group, respectively The mean number of sessions needed until the time of evaluation was 2.4 +/- 1.1 in the combined therapy group versus 5.1 +/- 2.3 sessions in the sclerosis group. The difference showed high s tatistical significance (p < 0.01). Minor complications occurred less frequently in the combined therapy group, Only one patient in the comb ined therapy group developed portal pyemia after extension of the tiss ue adhesive material from the site of injection into the portal vein, This patient died of hepatic failure. The mortality in the combined th erapy group was lower than that in the sclerosis group (3.5% and 8.8% respectively, p > 0.05). Conclusion: The combined use of tissue adhesi ve and sclerosant materials seems to be the best plan for rapid eradic ation of esophagogastric varices within a short time, requiring the lo west number of injection sessions and involving minor complications an d low mortality.