Drug & Device Development

Cyanoacrylate injection advised for high-risk gastric varices

Last Updated: 2010-12-22 16:18:02 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - Cyanoacrylate injections are more effective than beta-blockers at preventing a first hemorrhage from large or high-risk gastric varices, a new study from India shows.

"Cyanoacrylate injection should be the first line of treatment for primary prophylaxis of 'high risk' fundal gastric varices," according to senior author Dr. Shiv Kumar Sarin of the Institute of Liver & Biliary Sciences, New Delhi, and colleagues.

"Beta blockers are not effective" for this purpose, they add.

As reported online December 9 in the Journal of Hepatology, all 89 patients in the trial (ages 10 to 71) had cirrhosis and either isolated gastric varices or gastro-esophageal varices at least 10 mm in size. Their varices had not bled in the past.

Participants were randomized to receive endoscopic cyanoacrylate injection, beta-blocker therapy or no treatment.

Beta-blocker treatment consisted of propranolol, started at 20 mg twice daily and increased until the target heart rate of 55/min or the maximal dose of 360 mg/day was reached. The mean daily dose was 140 mg.

Over a median follow-up of 26 months, bleeding was seen in only 10% of patients in the cyanoacrylate group, versus 38% in the beta-blocker group and 53% in the no treatment group.

Based on actuarial probability of GV bleeding, the risk in the cyanoacrylate group was significantly lower than that in either of the other two groups. The difference in probability of bleeding between the beta-blocker group and the no treatment group was not statistically significant.

Over the same follow-up, overall mortality was significantly lower in the cyanoacrylate group (7%) than in the no treatment group (26%). Other between-group differences were not significant.

On multivariate analysis, gastric varices more than 20 mm in size, MELD (Model for End Stage Liver Disease) score of 17 or higher, and portal hypertensive gastropathy were independently correlated with variceal bleeding. A MELD score of at least 17 and gastric variceal bleeding were independently correlated with mortality.

"It remains to be seen whether a combination of treatment with cyanoacrylate injection and beta-blockers would offer greater benefit than either of the treatments given alone," the authors conclude.

SOURCE: http://link.reuters.com/pah92r

J Hepatol 2010.