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Eur J Gastroenterol Hepatol. 2014 Aug;26(8):846-52. doi: 10.1097/MEG.0000000000000119.

Outcomes of endoscopic human thrombin injection in the management of gastric varices.

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1
Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Abstract

OBJECTIVE:

Endoscopic human thrombin injection appears to be a technically simple and efficacious alternative to tissue adhesives with fewer complications; however, data remain limited. We analysed our experience using endoscopic human thrombin injection for gastric varices in a tertiary referral liver unit.

METHODS:

Thirty patients received thrombin injection for gastric varices between December 2008 and January 2013. Twenty patients (67%) had active bleeding or signs of recent bleeding at endoscopy. Ten patients (33%) received thrombin for prophylaxis of rebleeding: secondary (eight patients) and primary (two patients).

RESULTS:

The mean thrombin dose/injection was 1100‚ÄČIU (range 400-2500); the mean number of sessions was two (range 1-9), with no reported complications. Haemostasis was achieved in 18 out of 20 (90%) patients treated acutely. Failure to control bleeding (bleeding before day 5) was seen in seven patients: three died and four were managed successfully [two with further thrombin and two using a salvage transjugular intrahepatic portosystemic shunt (TIPSS)]. Rebleeding occurred in a further four patients, all managed successfully with salvage TIPSS. In the prophylaxis group, rebleeding occurred in two out of 10 patients.The median follow-up period was 672 days (interquartile range 92-1331). One patient underwent liver transplantation. Ten deaths occurred in total: four due to gastric variceal bleeding. Six-week survival was 83%. In cases in which TIPSS was precluded, 91% of patients (10 out of 11 patients) were managed successfully with thrombin.

CONCLUSION:

Endoscopic thrombin therapy for gastric variceal bleeding may have most utility as a safe and easily applied bridge to more definitive therapy, in secondary prophylaxis of rebleeding and in cases in which TIPSS is precluded.

PMID:
24892515
DOI:
10.1097/MEG.0000000000000119
[Indexed for MEDLINE]

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