Modified percutaneous transhepatic variceal embolization with 2-octylcyanoacrylate for bleeding gastric varices: long-term follow-up outcomes.

Abstract

The objective of our study was to evaluate the long-term efficacy and safety of a modified percutaneous transhepatic variceal embolization procedure with 2-octylcyanoacrylate (2-OCA) in the treatment of gastric variceal bleeding. From January 2003 to December 2008, 71 patients with a history of gastric variceal bleeding underwent modified percutaneous transhepatic variceal embolization with 2-OCA in our hospital: 12 patients with acute gastric variceal bleeding underwent emergency obliteration and the remaining 59 patients with recent variceal bleeding underwent modified percutaneous transhepatic variceal embolization as a secondary prophylaxis. The initial hemostasis rate, rebleeding rate, survival rate, and complications were evaluated. Complete obliteration--that is, all the gastric varices and their feeding veins were obliterated--was achieved after the percutaneous transhepatic variceal embolization procedure in 67 patients (94.4%). Acute variceal bleeding was arrested after the procedure in all 12 patients (100%). The mean follow-up period was 24.2 ± 12.4 (SD) months (range, 6-62 months). During the follow-up period, the cumulative probability of remaining free of gastric variceal rebleeding in patients with complete obliteration was 100%, 88.2%, and 88.2% at 1, 3, and 5 years after the procedure, respectively. Follow-up CT revealed that the modified percutaneous transhepatic variceal embolization procedure with 2-OCA can achieve long-lasting obliteration in the entire varices and in all the feeding veins. The cumulative survival rates at 1, 3, and 5 years after the procedure were 96.9%, 68.9%, and 53.7%. No severe complications occurred after the procedure. The modified percutaneous transhepatic variceal embolization with 2-OCA is considered to be an effective and safe method for the extensive and permanent obliteration of both gastric varices and their feeding veins.