Kanayan mide varislerinin n-butil-2-siyanoakrilat ve lipiodol karışımı enjeksiyonu ile başarılı endoskopik tedavisi

Amaç: Bu çalışmadaki amacımız kanayan veya daha önce kanamış olan gastrik varislerde syanoacrilat ve lipiodol karışımının hemostazdaki etkisini saptamaktır. Gereç ve yöntem: 2003-2010 tarihleri arasında aktif kanayan veya kanama bulgusu olan ve iki hafta içinde endoskopi ünitesine kabul edilen 15 hasta retrospektif olarak değerlendirildi. Syanoacrilat ve lipiodol karışımını gastrik varisli hastalarda başarılı şekilde uyguladık ve tüm hastalara endoskopik işlem, varisler başarılı şekilde tedavi edilene kadar aylık peryotlarla tekrarlandı. Bulgular: Syanoacrilatlı skleroterapi ile aktif kanayan 9 hastada başlangıçta hemostaz sağlandı. Tekrar kanama, 1 hastada 24 saat sonra diğer hastada 2 ay sonra görüldü (2/15, %13,3). Takip süresince gastrik varis eradikasyonu 13 hastada (%86,7) başarıldı. Bir hasta tekrar kanamadan opere edildi diğer hasta karaciğer yetmezliğinden öldü. Gastrik varis eradikasyonundan sonra 5 yıllık yaşam 14/15 (%93,3) idi. Sonuç: Bu çalışmada aktif kanayan ve kanama işareti olan gastrik varisli hastalarda syanoacrilat lipiodol kombinasyonu ile skleroterapinin etkili tedavisi gösterildi.

Anahtar Kelimeler:

Endoskopik skleroterapi, siyanoakrilat, lipiodol, gastrik varis

Successful endoscopic treatment of bleeding gastric varices with n-butyl-2-cyanoacrylate and lipiodol mixture injection

Objectives: The aim of this study was to determine effect of N-Butyl-2 Cyanoacrylate (CA) and lipiodol mixture injection for hemostasis of bleeding gastric varices or lesions, which had bled from gastric varices. Materials and methods Fifteen patients with active bleeding or bleeding findings within two weeks who admitted to endoscopic unit of a low volume medical center were evaluated retrospectively between 2003 and 2010. We carried out endoscopic sclerotherapy successfully to gastric varices with combination of N-Butyl-2 Cyanoacrylate and Lipiodol (CALM), with dramatical success over months after sessions of sclerotherapy for each patient. Results: Sclerotherapy with cyanoacrylate achieved hemostasis in all actively bleeding nine patients initially. Rebleeding occurred in a patient 24 hours later and in another patient two months later (2/15, 13.3%). Eradication of gastric varices was achived in 13 (86.7 %) patients during follow-up. One patient was operated because of rebleeding. One patient died as a result of liver failure. Five-year survival rate of the patients after eradication of gastric varices was 14/15 (93.3%). Conclution: This study indicated that sclerotherapy with N-Butyl-2 Cyanoacrylate and lipiodol mixture is an effective treatment method for patients with bleeding gastric varices and also for eradication of gastric varices.

Keywords:

Endoscopic sclerotherapy, cyanoacrylate, Lipiodol, gastric varices,

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