Efficacy of Thrombin Fibrin Glue and Sclerosant in the Management of Bleeding Gastric Varices

Gastric varices are noted in up to 20 % of patents with portal hypertension, and are more common in those with noncirrhotic etiology. They bleed at lower portal pressures, bleed more severely and are associated with higher rates of rebleed, encephalopathy and mortality. Variceal obliteration using tissue adhesives such as N-butyl cyanoacrylate leading to plugging and thrombosis of the gastric varices is currently the first line management option for obliteration of the gastric varices. Although various options have been proposed, gold standard for management of gastric variceal bleeds is yet to be defined. We theorized that injection of the gastric varices using thrombin based glue followed by injection of a sclerosant shall be effective in optimum sclerotherapy and eradication of gastric varices. MATERIAL AND METHODS: All patients presenting with gastric variceal bleed were offered sclerotherapy with Thrombin fibrin based glue and sclerosant (TFG/S). During the study period 18 patients were enrolled in the TGF/S group. 21 patients underwent variceal plugging with n-butyl cyanoacrylate (NBC). There was no significant difference in age/ sex, duration of bleed or time interval between onset of bleed and endotherapy. RESULTS: Patients undergoing endotherapy with TGF/S had less episodes of bleed, and greater eradication of varices. CONCLUSION: The results with thrombin/ fibrin glue and sclerotherapy are highly encouraging. Well-designed trials need to be performed to evaluate its efficacy.