THROMBIN - AN EFFECTIVE TREATMENT FOR GASTRIC VARICEAL HEMORRHAGE

The optimum treatment of gastric varices has still to be defined. Less er curve gastric varices may be treated by injection sclerotherapy, bu t this has a limited role in the treatment of fundal gastric varices. Surgical intervention is commonly needed but carries a high mortality in patients with advanced Liver disease. This study evaluated the use of thrombin for the treatment of gastric varices in 11 consecutive pat ients (nine with fundal, two with high lesser curve varices), identifi ed as having bled from this site. Bovine thrombin (1000 U/ml) was inje cted intravariceally (mean volume 5.5 ml, range 2-10 ml) producing ini tial haemostasis in all 11 cases. Varices were considered thrombosed o r obliterated in all patients after a median of two injection episodes (range 1-3). After a median follow up of nine months only one patient had rebled from a gastric varix. Thrombin may represent a valuable al ternative injectate for the treatment of gastric varices.