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Controlled trial of TIPS versus cyanoacrylate glue for gastric variceal bleeding
Letters to the editor
Controlled trial of TIPS versus cyanoacrylate glue for gastric variceal bleeding To the Editor: I read with interest the article by the ASGE Technology Committee regarding the tissue adhesive cyanoacrylate.1 The authors cited 2 retrospective studies that compared cyanoacrylate injection with transcutaneous intrahepatic portosystemic shunt (TIPS) for gastric variceal bleeding, and they presumed that glue injection is probably equivalent to TIPS. Actually, we performed a prospective, randomized, controlled trial comparing glue injection and TIPS in the prevention of gastric variceal rebleeding.2 Our study enrolled 37 patients in the glue group and 35 patients in the TIPS group. After a median follow-up of 33 months, rebleeding from gastric varices was encountered in 38% of the glue group and 11% of the TIPS group (P ! .01). Survival and frequency of adverse events were similar in both groups. Our conclusion was that TIPS proved more effective than glue injection in terms of preventing gastric variceal rebleeding.
bleeding gastric varices,2 which was inadvertently left out of our review article. Their well-done study randomized patients with bleeding gastric varices to TIPS versus glue therapy after endoscopic hemostasis had already been achieved with cyanoacrylate glue. They are indeed correct that for long-term management, TIPS was found to be superior to glue therapy with respect to rebleeding and variceal obliteration rates. Although the literature does support the assertion we made in our article regarding the efficacy of TIPS versus glue in the initial management of gastric variceal hemorrhage, we appreciate the opportunity to highlight this important randomized study, which shows that TIPS is more efficacious in the long termda dissimilar result to a previous retrospective study that showed no difference in outcomes at 1 year.3 It is worth mentioning that many patients with variceal hemorrhage are not candidates for TIPS because of severe hepatic dysfunction and that TIPS is not available in all centers. The use of cyanoacrylate glue may be the only viable option for primary control of hemorrhage in this difficult clinical situation.
DISCLOSURE DISCLOSURE The author disclosed no financial relationships relevant to this publication. Gin-Ho Lo, MD Department of Medical Research Digestive Center E-DA Hospital Kaohsiung, Taiwan
REFERENCES 1. ASGE Technology Committee, Bhat YM, Banerjee S, Barth BA, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc 2013;78:209-15. 2. Lo GH, Liang HL, Chen WC, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt vs. cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007;39:679-85.
The author disclosed no financial relationships relevant to this publication. Sarah Rodriguez, MD Department of Gastroenterology Oregon Health and Science University Portland, Oregon, USA REFERENCES 1. Bhat Y, Banerjee S, Barth B, et al, and the ASGE Technology Assessment Committee. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc 2013;78:209-15. 2. Lo G, Liang H, Chen W, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007;39:679-85. 3. Procaccini N, Al-Osaimi A, Northup P, et al. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc 2008;70: 881-7. http://dx.doi.org/10.1016/j.gie.2013.09.009
http://dx.doi.org/10.1016/j.gie.2013.08.011
Response: We appreciate the interest in our technology review of tissue adhesives and cyanoacrylate glue.1 Our article stated that transjugular intrahepatic portosystemic shunt (TIPS) is probably equivalent to cyanoacrylate glue for initial hemostasis for gastric variceal hemorrhage. As the authors point out, they published a study comparing TIPS with endoscopic therapy with cyanoacrylate glue for 182 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 1 : 2014
Novel irregular vascular pattern features of serrated adenoma detected by high-definition iScan endoscopic technique To the Editor: We have read with interest the article by Hazewinkel et al,1 who assessed and validated the endoscopic findings of sessile serrated adenoma/polyp (SSA/P) using high-resolution white-light endoscopy (HR-WLE) www.giejournal.org
Controlled trial of TIPS versus cyanoacrylate glue for gastric variceal bleeding To the Editor: I read with interest the article by the ASGE Technology Committee regarding the tissue adhesive cyanoacrylate.1 The authors cited 2 retrospective studies that compared cyanoacrylate injection with transcutaneous intrahepatic portosystemic shunt (TIPS) for gastric variceal bleeding, and they presumed that glue injection is probably equivalent to TIPS. Actually, we performed a prospective, randomized, controlled trial comparing glue injection and TIPS in the prevention of gastric variceal rebleeding.2 Our study enrolled 37 patients in the glue group and 35 patients in the TIPS group. After a median follow-up of 33 months, rebleeding from gastric varices was encountered in 38% of the glue group and 11% of the TIPS group (P ! .01). Survival and frequency of adverse events were similar in both groups. Our conclusion was that TIPS proved more effective than glue injection in terms of preventing gastric variceal rebleeding.
bleeding gastric varices,2 which was inadvertently left out of our review article. Their well-done study randomized patients with bleeding gastric varices to TIPS versus glue therapy after endoscopic hemostasis had already been achieved with cyanoacrylate glue. They are indeed correct that for long-term management, TIPS was found to be superior to glue therapy with respect to rebleeding and variceal obliteration rates. Although the literature does support the assertion we made in our article regarding the efficacy of TIPS versus glue in the initial management of gastric variceal hemorrhage, we appreciate the opportunity to highlight this important randomized study, which shows that TIPS is more efficacious in the long termda dissimilar result to a previous retrospective study that showed no difference in outcomes at 1 year.3 It is worth mentioning that many patients with variceal hemorrhage are not candidates for TIPS because of severe hepatic dysfunction and that TIPS is not available in all centers. The use of cyanoacrylate glue may be the only viable option for primary control of hemorrhage in this difficult clinical situation.
DISCLOSURE DISCLOSURE The author disclosed no financial relationships relevant to this publication. Gin-Ho Lo, MD Department of Medical Research Digestive Center E-DA Hospital Kaohsiung, Taiwan
REFERENCES 1. ASGE Technology Committee, Bhat YM, Banerjee S, Barth BA, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc 2013;78:209-15. 2. Lo GH, Liang HL, Chen WC, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt vs. cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007;39:679-85.
The author disclosed no financial relationships relevant to this publication. Sarah Rodriguez, MD Department of Gastroenterology Oregon Health and Science University Portland, Oregon, USA REFERENCES 1. Bhat Y, Banerjee S, Barth B, et al, and the ASGE Technology Assessment Committee. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc 2013;78:209-15. 2. Lo G, Liang H, Chen W, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007;39:679-85. 3. Procaccini N, Al-Osaimi A, Northup P, et al. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc 2008;70: 881-7. http://dx.doi.org/10.1016/j.gie.2013.09.009
http://dx.doi.org/10.1016/j.gie.2013.08.011
Response: We appreciate the interest in our technology review of tissue adhesives and cyanoacrylate glue.1 Our article stated that transjugular intrahepatic portosystemic shunt (TIPS) is probably equivalent to cyanoacrylate glue for initial hemostasis for gastric variceal hemorrhage. As the authors point out, they published a study comparing TIPS with endoscopic therapy with cyanoacrylate glue for 182 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 1 : 2014
Novel irregular vascular pattern features of serrated adenoma detected by high-definition iScan endoscopic technique To the Editor: We have read with interest the article by Hazewinkel et al,1 who assessed and validated the endoscopic findings of sessile serrated adenoma/polyp (SSA/P) using high-resolution white-light endoscopy (HR-WLE) www.giejournal.org