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급성 위식도정맥류 출혈에 내시경 N-butyl-2-cyanoacryl주입요법의 효과 TIPS의 치료 효과와의 비교 검토
노두영 ( No Du Yeong ),박선영 ( Park Seon Yeong ),주소영 ( Ju So Yeong ),박창환 ( Park Chang Hwan ),이완식 ( Lee Wan Sig ),주영은 ( Ju Yeong Eun ),김현수 ( Kim Hyeon Su ),최성규 ( Choe Seong Gyu ),유종선 ( Yu Jong Seon ),김세종 ( 대한소화기학회 2004 대한소화기학회지 Vol.43 No.3
Background/Aims: Though endoscopic therapies such as variceal ligation and sclerotherapy has been performed, bleeding from the large esophageal and gastric varices still poses significant risk of death. Decrease of portal pressure by TIPS (transjugular intrahepatic portosystemic shunt) or surgical shunt was indicated as cause of failure of endoscopic therapies. Treatment of N-butyl-2-cyanoacrylate has been especially effective for gastric variceal bleeding, but comparison with other treatments had not been reported yet. In this study, the effect of cyanoacrylate injection therapy was cross-examined with the result of TIPS in acute esophagogastric variceal bleedings. Methods: From April 1995 to June 2002, endoscopic cyanoacrylate injection therapy (43 cases) and TIPS (63 cases) were performed in our hospital. Each group was analysed regarding their clinical results including initial hemostasis rate, rebleeding rate, survival duration, mortality and morbidity. Results: Initial hemostasis rate was 95.3% in cyanoacrylate group and 92.1% in TIPS group. Cumulative probability of rebleeding was not different between two groups. Overall complication rates associated with the procedure were 50.8% in TIPS group and 9.3% in cyanoacrylate group. There was no significant difference between two groups in their survival rates. Conclusions: Cyanoacrylate injection therapy was relatively safe, and has comparable results with TIPS for uncontrollable and severe esophagogastric variceal bleedings. (Korean J Gastroenterol 2004;43:186-195)