식도정맥류 출혈에서 Histoacryl의 치료효과; 식도정맥류 결찰요법과의 비교 = N-Butyl-2-Cyanoacrylate(Histoacryl) in the Treatment of Esophageal Variceal Bleeding; Comparison with Band Ligation

다국어 초록 (Multilingual Abstract)

Background/Aim: Endoscopic sclerotherapy and band ligation have been well documented beneficial therapeutic options of esophageal variceal bleeding. But acute variceal bleeding is refractory to sclerotherapy in upto one-third of patients, and rebleeding occurs in 30% to 50%. Recently alternative endoscopic modality, N-butyl-2-cyanoacrylate (Histoacryl) injection is performed in intravariceal sclerotherapy but its efficacy and safty are not clearly established. We evaluated the efficacy of Histoacryl on esophageal variceal bleeding and compared with that of endoscopic band ligation in the present study. Materials/Methods: From March 1994 to March 1998, ninety seven patients with endoscopically documented esophageal variceal bleeding were enrolled. Histoacryl injection (Histoacryl group, n=33) or endoscopic band ligation (EVL group, n=64) was done for esophageal variceal bleeding. We evaluated the rebleeding rate and in-hospital mortality in both groups. Results: Baseline characteristics were similar but active bleeding on first endoscopic session was significantly higher in Histoacryl group (Histoacryl group; 90.7%, EVL group; 26.6%, p=0.002). Successful hemostasis was done at 87.9% in Histoacryl group, 95.3% in EVL group (not significant). There were no significant differences on early rebleeding rate (18.2% vs 23.4%), late rebleeding rate (39.4% vs 37.5%) and in-hospital mortality (24.2% vs 15.6%) between Histoacryl group and EVL group. There were no technique-related fatal complications at Histoacryl injection group. Conclusion: Therapeutic efficacy of Histoacryl injection was similar to the endoscopic band ligation in patients with esophageal varix bleeding in terms of hemostasis and rebleeding. Histoacryl is effective therapeutic option for esophageal variceal bleeding as well as gastric variceal bleeding. (Korean J Hepatol 1999;5:306－313)