Endoscopic clipping combined with cyanoacrylate injection vs. transjugular intrahepatic portosystemic shunt in the treatment of isolated gastric variceal bleeding: Randomized controlled trial

IF 5 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive Endoscopy Pub Date : 2024-09-10 DOI:10.1111/den.14916
Jing Li, Zhaoyi Chen, Yaxian Kuai, Fumin Zhang, Huixian Li, Derun Kong
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Abstract

ObjectivesAlthough the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC‐CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.MethodsIn a single‐center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC‐CYA group or TIPS group. The primary end‐points were gastric variceal rebleeding rates and technical success. Secondary end‐points included cumulative nonbleeding rates, mortality, and complications.ResultsA total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC‐CYA group (n = 76) and TIPS group (n = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC‐CYA group and 8.8% in the TIPS group, showing no significant difference (P = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (P = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (P = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (P = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC‐CYA group (P = 0.001).ConclusionBoth groups are effective in controlling IGV1 bleeding. Notably, EC‐CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS.
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治疗孤立性胃底静脉曲张出血的内镜下夹闭联合氰基丙烯酸酯注射与经颈静脉肝内门体分流术的对比:随机对照试验
目的虽然1型孤立性胃静脉曲张(IGV1)出血的发生率很低,但该病非常危险,死亡率很高,因此治疗难度很大。方法在一项单中心随机对照试验中,IGV1 型出血患者被随机分配到 EC-CYA 组或 TIPS 组。主要终点是胃静脉曲张再出血率和技术成功率。结果 在2019年1月至2023年4月期间,共挑选了156名患者,随机分配到EC-CYA组(n = 76)和TIPS组(n = 80)。两组的技术成功率均为 100%。EC-CYA组和TIPS组的再出血率分别为14.5%和8.8%,无显著差异(P = 0.263)。Kaplan-Meier 分析显示,两组患者在 6、12、24 和 36 个月的累积不出血率缺乏统计学意义(P = 0.344)。同样,两组患者在 12、24 和 36 个月的累积存活率也没有统计学意义(P = 0.916)。两组因其他原因引起的出血率分别为 13.2% 和 6.3%,无显著差异(P = 0.144)。两组均未观察到异位栓塞。TIPS 组的肝性脑病(HE)发生率在统计学上高于 EC-CYA 组(P = 0.001)。值得注意的是,EC-CYA 不会导致异位栓塞,而且 HE 的发生率低于 TIPS。
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来源期刊
Digestive Endoscopy
Digestive Endoscopy 医学-外科
CiteScore
10.10
自引率
15.10%
发文量
291
审稿时长
6-12 weeks
期刊介绍: Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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Issue Information Cover Image WEO Newsletter: Tips and Tricks for Endoscopic Ultrasound guided Celiac Plexus interventions Failed endoscopic ultrasound-guided gallbladder drainage across the duodenal covered metallic stent salvaged by using a forward-viewing linear echoendoscope. Cover Image
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