Endoscopy 2003; 35(8): 675-678
DOI: 10.1055/s-2003-41517
Original Article

© Georg Thieme Verlag Stuttgart · New York

Use of Fibrin Glue (Beriplast) in the Management of Bleeding Gastric Varices

D.  Datta1 , P.  Vlavianos1 , A.  Alisa1 , D.  Westaby1
  • 1Dept. of Gastroenterology, Chelsea and Westminster Hospital, London, UK
Further Information

Publication History

Submitted 20 April 2003

Accepted after Revision 13 May 2003

Publication Date:
20 August 2003 (online)

Background and Aims: Gastric variceal bleeding is a serious complication of portal hypertension. The optimum endoscopic treatment of bleeding gastric varices is yet to be defined. We evaluated the use of Beriplast, which is a solution of fibrinogen and thrombin, in controlling gastric variceal bleeding.
Patients and Methods: Fifteen patients presenting with gastric variceal bleeding were entered into an open trial of endoscopic gastric intravariceal injection treatment with Beriplast (fibrin sealant) and followed for up to 1 month after endoscopic treatment.
Results: There was failure to control bleeding in one patient. Four patients had rebleeding after the index bleed. All four were reinjected with Beriplast, and the bleeding was controlled in three. All patients were followed for 30 days, and the 30-day mortality following injection treatment was one. Fourteen patients were discharged from the hospital after the first episode of gastric variceal bleeding. None of the patients had injection-induced complications.
Conclusions: These results show that Beriplast is a safe and simple endoscopic treatment option and is very effective in controlling gastric variceal bleeding.

References

  • 1 Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices.  Gastrointest Endosc. 1986;  32 264-268
  • 2 Korula J, Chin K, Ko Y, Yamada S. Demonstration of two distinct subsets of gastric varices: observations during a 7 year study on endoscopic therapy.  Dig Dis Sci. 1991;  36 303-309
  • 3 Tetushiro K, Hiroshi S, Hiroshi K. et al . Risk factors for haemorrhage from gastric fundal varices.  Hepatology. 1997;  25 307-312
  • 4 Sarin S K, Laholi D, Saxena S P. et al . Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients.  Hepatology. 1992;  16 1343-1349
  • 5 Hoskin S W, Johnson A G. Gastric varices: a proposed classification of gastric varices leading to management.  Br J Surg. 1988;  75 747-750
  • 6 Sarin S K. Long-term follow-up of gastric variceal sclerotherapy: an eleven-year experience.  Gastrointest Endosc. 1997;  46 8-14
  • 7 Chang K Y, Wu C S, Chen P C. Prospective randomized trial of hypertonic glucose water and sodium tetradecyl sulfate for gastric variceal bleeding in patients with advanced liver cirrhosis.  Endoscopy. 1996;  28 481-486
  • 8 Gimson A ES, Westaby D, Williams R. Endoscopic sclerotherapy in the management of gastric variceal haemorrhage.  J Hepatol. 1991;  13 274-278
  • 9 Takeuchi M, Nakai Y, Syu A. et al . Endoscopic ligation of gastric varices.  Lancet. 1996;  348 1038
  • 10 Yoshida T, Hayashi N, Suzumi N. et al . Endoscopic ligation of gastric varices using a detachable snare.  Endoscopy. 1994;  26 502-505
  • 11 Oho K, Iwao T, Sumino M. et al . Ethanolamine oleate versus butyl cyanoacrylate for bleeding varices: a nonrandomized study.  Endoscopy. 1995;  27 349-354
  • 12 Ogawa K, Ishikawa S, Naritaka Y. et al . Clinical evaluation of endoscopic injection sclerotherapy using N-butyl-2-cyanoacrylate for gastric variceal bleeding.  J Gastroenterol Hepatol. 1999;  14 245-250
  • 13 Huang Y H, Yeh H Z, Chen G H. et al . Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety.  Gastrointest Endosc. 2000;  52 160-167
  • 14 Ramond M J, Valla D, Mosnier J F. et al . Successful endoscopic obturation of gastric varices with butyl cyanoacrylate.  Hepatology. 1989;  10 488-493
  • 15 See A, Florent C, Lamy P. et al . Accidents vasculaires cérébaux après obturation endoscopique des varices oesophagiennes par isobutyl-2-cyanoacrylate chez deux malades.  Gastroenterol Clin Biol. 1986;  10 488-493
  • 16 Williams S GJ, Peters R A, Westaby D. Thrombin: an effective treatment for gastric variceal haemorrhage.  Gut. 1994;  35 1287-1289
  • 17 Przemiosle R T, McNair A, Williams R. Thrombin is effective in arresting bleeding from gastric variceal haemorrhage.  Dig Dis Sci. 1999;  44 778-781
  • 18 Zimmer T, Rucktaschel F, Stolzel V. et al . Endoscopic sclerotherapy with fibrin glue as compared with polidocanol to prevent early oesophageal variceal rebleeding.  J Hepatol. 1998;  28 292-297
  • 19 Wallis K, Vlavianos P, Andreyev H JN, Westaby D. Fibrin glue injection for the treatment of acute upper gastrointestinal bleeding.  Gut. 2002;  50 A12(045)
  • 20 Jalan R, Hayes P C. UK guidelines on the management of variceal haemorrhage in cirrhotic patients.  Gut. 2000;  46 1-15
  • 21 Rigo G P, Merighi A, Chahin N J. et al . A prospective study of the ability of three endoscopic classifications to predict hemorrhage from oesophageal varices.  Gastrointest Endosc. 1992;  38 425-429

D. Datta, M.D.

Dept. of Gastroenterology · Chelsea and Westminster Hospital

369 Fulham Road · London SW10 9NH · UK

Fax: +44-20-874-68100

Email: dattauk@yahoo.co.uk