Bleeding Gastric Varices: Frequency and Outcome
Elsamman, M., Morsy, K., Mohammad, A., Ali, W. (2018). Bleeding Gastric Varices: Frequency and Outcome. EKB Journal Management System, 22(3), 395-401. doi: 10.21608/smj.2018.39409
Mahmoud Kamal Elsamman; Khairy Morsy; Asmaa Naser Mohammad; Walaa Ali. "Bleeding Gastric Varices: Frequency and Outcome". EKB Journal Management System, 22, 3, 2018, 395-401. doi: 10.21608/smj.2018.39409
Elsamman, M., Morsy, K., Mohammad, A., Ali, W. (2018). 'Bleeding Gastric Varices: Frequency and Outcome', EKB Journal Management System, 22(3), pp. 395-401. doi: 10.21608/smj.2018.39409
Elsamman, M., Morsy, K., Mohammad, A., Ali, W. Bleeding Gastric Varices: Frequency and Outcome. EKB Journal Management System, 2018; 22(3): 395-401. doi: 10.21608/smj.2018.39409

Bleeding Gastric Varices: Frequency and Outcome

Sohag Medical Journal
Article 48, Volume 22, Issue 3, October 2018, Page 395-401  XML PDF (79.2 K)
Document Type: Original Article
DOI: 10.21608/smj.2018.39409
View on SCiNiTO View on SCiNiTO
Authors
Mahmoud Kamal Elsamman1; Khairy Morsy2; Asmaa Naser Mohammad2; Walaa Ali2
1Department of Internal medicine, Faculty of Medicine, Sohag University.
2Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University.
Abstract
Background and aims: Gastric variceal (GV) bleeding is less frequent than esophageal variceal (EV) bleeding but it is still a serious cause of morbidity and mortality.The aim of study was to assess the frequency and identify the patients' outcome after management.
Patients and methods: The study was conducted on 500 cirrhotic patients with upper gastrointestinal bleeding the period from June 2016 to June 2017.All patients were subjected to complete history taking, clinical examination, laboratory investigations, abdominal US and esophago-gastro-duodenoscopy (EGD) for detection of the source of bleeding. If bleeding GVs were detected, Cyanoacrylate was injected into them to achieve primary haemostasis.
Results: Endoscopic examination revealed bleeding GV in 50 patients (10 %), bleeding EV in 400 patients (80%), while bleeding from other sources was in 50 patients (10%).In the GV group, thirty-five patients (70%) had isolated GV (type I)  and 15 patients (30%) had continuous Gastroesophogeal varices (type 2).Most patients (80%) with GV had red colour signs (Rc+).PHG was seen in 48 patients (96%).
After Cyanoacrylate injection of GV, 40% developed eradication, 38% died & 22% developed re-bleeding.Upon studying the predictors of mortality, we found that patients who died had significantly lower albumin & higher ALT & AST levels. Early re-bleeding was more common among Child A patients with moderately sized GV (F2), but the difference was not statisticallysignificant. By multivariate analysis we found no independent predictors of mortality or re-bleeding.
Conclusions: Bleeding GVs represents 10% of upper GIT bleeding in cirrhotic patients. No independent factors could predict the mortality or re-bleeding among cirrhotic patients with bleeding GVs by multivariate analysis.
Keywords
gastric varices; Bleeding; predictors of mortality; predictors of re-bleeding
Supplementary Files
References
  1. KAPSORITAKIS AN, NTOUNAS EA, MAKRIGIANNIS EA, NTOUNA EA, LOTIS VD, PSYCHOS AK, ET AL (2009): Acute upper gastrointestinal bleeding in central Greece: the role of clinical and endoscopic variables in bleeding outcome. Digestive diseases and Science. 54(2):333-41.
  2.  CARBONELL N, PAUWELS A, SERFATY L, FOURDAN O, LEVY VG, POUPON R (2004): Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology (Baltimore, Md). 40(3):652-9.
  3. BM Ryan, RW Stockbrugger, JM Ryan (2004): Pathophysiologic , gastroenterologic and radiologic approch to mangement of gastric varices. Gastroenterology 126(4) : 1175-1189.
  4. SANYAL AJ (2000):  The value of EUS in the management of portal hypertension. Gastrointest Endoscopy 52:575–7.
  5.  TAJIRI T, ONDA M, YOSHIDA H, MAMADA Y, TANIAI N, YAMASHITA K (2002): The natural history of gastric varices. Hepatogastroenterology. 49: 1180-2.
  6. SARIN, S K & LAHOTI, D (1992). Management of gastric varices. Baillieres Clin Gastroenterol, 6, 527-48(1992 ) .
  7. HASHIZUME, M, KITANO, S, YAMAGA, H, KOYANAGI, N & SUGIMACHI, K (1990): Endoscopic classification of gastric varices. Gastrointest Endosc, 36, 276-80.
  8. KIM, T, SHIJO, H, KOKAWA, H, TOKUMITSU, H, KUBARA, K, OTA, K, AKIYOSHI, N, IIDA, T, YOKOYAMA, M & OKUMURA, M (1997):  Risk factors for hemorrhage from gastric fundal varices. Hepatology, 25, 307-12
  9. WANI, Z A, BHAT, R A, BHADORIA, A  S, MAIWALL, R & CHOUDHURY A (2015): Gastric varices: Classification, endoscopic and ultrasonographic management. J Res Med Sci 20, 1200-7                                              KOZIEL, S, KOBRYN, K, PALUSZKIEWICZ, R, KRAWCZYK, M & WROBLEWSKI, T (2015): Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2 cyanoacrylate. Prz Gastroenterol, 10, 239-43.
  10.  MUMTAZ, K, MAJID, S, SHAH, H, HAMEED, K, AHMED, A, HAMID, S  & JAFRI, W (2007): Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding. World J Gastroenterol, 13, 1247-51 .
  11. BUTT, Z, ALI SHAH, S  M, AFZAL, M, YOUNIS, I , WAQAS, M & ATTA, H. Frequency of different types of gastric varices in patients with cirrhosis due to chronic hepatitis C. J Pak Med Assoc, 66, 1462-1465 (2016)
  12. KHAWAJA, A, SONAWALLA, A  A, SOMANI, S F & ABID, S (2014): Management of bleeding gastric varices: a single session of histoacryl injection may be sufficient. Eur J Gastroenterol Hepatol, 26, 661-7 
  13. CHIU, P  W & NG, E  K (2009): Predicting poor outcome from acute upper gastrointestinal hemorrhage. Gastroenterol Clin North Am, 38, 215-30.
  14. BAMBHA, K, KIM, W R, PEDERSEN, R, BIDA, J P, KREMERS, W K & KAMATH, P S (2008): Predictors of early re-bleeding and mortality after acut variceal haemorrhage in patients with cirrhosis. Gut, 57, 814-20.

 

 

 
 

 

 

 

 

 

 

 

Statistics
Article View: 181
PDF Download: 292