INJECTION SCLEROTHERAPY FOR VARICEAL BLEEDING IN PATIENTS WITH HEPATOCELLULAR-CARCINOMA - CYANOACRYLATE VERSUS SODIUM TETRADECYL SULFATE

Background: Patients with hepatocellular carcinoma complicated by vari ceal bleeding have a very limited life span. Recurrent bleeding after endoscopic injection sclerotherapy is common. Our aim was to compare t he efficacy of endoscopic injection of cyanoacrylate versus sodium tet radecyl sulphate in the control of variceal bleeding in patients with hepatocellular carcinoma. Methods: Patients known to be suffering from inoperable hepatocellular carcinoma who presented with upper gastroin testinal bleeding underwent endoscopy within 24 hours of admission. Af ter bleeding from esophageal varices was confirmed, they were randomiz ed to receive endoscopic injections of either cyanoacrylate (1:1 mixtu re with Lipoidol) or sodium tetradecyl sulphate (1.5%). Injection were given intravariceally into each visible column for up to four injecti ons for cyanoacrylate and up to 30 mL for sodium tetradecyl sulphate. Results: A total of 50 patients were recruited for this study with 25 cases randomized to each endoscopic treatment group. Control of acute bleeding failed in four patients (16%) in both treatment groups, and t wo patients in each group died during the index episode of bleeding. S ix patients (24%) in the cyanoacrylate group and four patients (16%) i n the sodium tetradecyl sulphate group developed recurrent bleeding du ring their hospital stay (p = 0.48). Recurrent bleeding within 30 days after the index episode of bleeding was documented in seven patients (28%) who received cyanoacrylate injection and five patients (20%) who received sodium tetradecyl sulphate injection (p = 0.51). Median surv ival in the cyanoacrylate group was 16 days (range 1 to 485 days) and that of the sodium tetradecyl sulphate group was 13 days (range 1 to 4 07 days). There was no difference in cumulative survival between the t wo groups as analyzed by the Kaplan-Meier method. Patients with portal vein thrombosis had a higher risk of recurrent hemorrhage. Patients w ith Child's C liver disease had a significantly higher mortality. Conc lusions: Cyanoacrylate did not improve the outcome of hepatocellular c arcinoma patients with variceal hemorrhage.