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Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency that results in significant morbidity, mortality, and socioeconomic burden. Both types of cardio-fundal varices, gastro-esophageal varix 2 (GOV2) and isolated gastric varices type 1 (IGV1), can cause massive bleeding and often are difficult to treat compared to the other types of gastric varices. Endoscopic variceal band ligation (EVBL) is a less effective treatment modality for gastric varices than esophageal varices and is associated with high re-bleeding rates. N-butyl-2-cyanoacrylate (Histoacryl) injection is an effective and potential treatment option for fundal varices. This study aims to evaluate the safety and efficacy of n-butyl-2-cyanoacrylate injection therapy in cardio-fundal varices. Objective To assess the efficacy and safety of n-butyl-2-cyanoacrylate injection therapy for fundal varices. Methods This retrospective observational cohort study was conducted at the Department of Gastroenterology, Allied Teaching Hospital, Gujranwala, over one year. All patients, irrespective of age and gender, presenting with UGIB and in whom fundal varices were diagnosed on gastroscopy followed by n-butyl 2-cyanoacrylate injection therapy were included in this study. The efficacy and safety of Histoacryl therapy were assessed by analyzing successful hemostasis, frequency of re-bleeding, obliteration, and regression of fundal varices on repeat endoscopy. Adverse events such as re-bleeding and mortality related to fundal variceal treatment were documented. Results A total of 60 patients were included in the study. Of these, 70% had IGV1, while the remaining 30% had GOV2. Hemostasis was achieved in 100% of patients following n-butyl-2-cyanoacrylate injection. Successful obliteration with regression of varices was observed in 91.3% of patients. Various adverse events were observed, with abdominal pain being the most common observed complication in 18.3% of participants. However, only 8.3% of participants developed re-bleeding due to ulcer formation at the injection site, and no death occurred directly due to fundal variceal treatment. Conclusion N-butyl-2-cyanoacrylate injection therapy is a lifesaving, effective, and safe intervention for controlling bleeding from cardio-fundal varices, leading to improved health status and a consequent decrease in episodes of recurrent bleeding. Its side effects are few and infrequent. However, larger-scale studies are needed to further evaluate the safety and effectiveness of n-butyl-2-cyanoacrylate injection therapy. These studies will be crucial in establishing comprehensive guidelines for the management of fundal varices.
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OBJECTIVE: The study aimed to assess the safety profile of Direct Acting Anti-Viral's (DAAs) among patients with chronic Hepatitis C Virus (HCV). METHODS: This multicenter, analytical cross-sectional study was conducted in six gastroenterology and Hepatology centers including Liver Center Faisalabad, Allama Iqbal Medical Institute and Liver Center DHQ Hospital Sialkot, Isra Hospital Hyderabad, Allied Hospital Faisalabad and Rehman Medical Institute Peshawar, between May 2018 and May 2019. The data regarding patient demographics, treatment plan and the frequency of Adverse Events (AEs), and their severity was collected using a pre-designed questionnaire and analyzed through SPSS version 20.0. RESULTS: A total of 511 HCV patients were enrolled, with an overall male majority. Around 66.3% patients experienced a total of 419 AEs, out of which 61 events were suspected from DAAs while remaining 317 events were associated with Ribavirin. Pyrexia (24.6%) and fatigue (14.8%) were the most commonly reported AEs among patients receiving DAAs. Factors such as Ribavirin-based treatments and the presence of Cirrhosis were more likely to promote AEs occurrence OR [95%CI] i.e. 5.2(2.3-9.1) and 1.9(1.1-3.1) respectively (p < 0.05). CONCLUSION: It is concluded from the study results that DAAs have displayed promising outcomes due to the minimal and minor AEs reported.
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OBJECTIVE: To find and analyse the associated determinants of mortality in admitted patients in cirrhotic patients with MELD score >18 presenting in emergency department with variceal bleeding. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, King Sultan Military Hospital Riyadh, Kingdom of Saudi Arabia, from July 2017 to January 2018. METHODOLOGY: A total of 235 patients fulfilling the inclusion criteria were enrolled in the study. Diagnosis of cirrhosis was made if the patients had platelets <150000/µl, PT >3 sec (prolonged), biochemical (reversal of ALT, AST ratio, albumin <3.5 g/dl) and ultrasongraphic coarse echotexture of liver and splenomegaly; and presence of all of the above variables and for at least six months. Variceal bleeding diagnosed on presentation and emergency endoscopy. MELD score was calculated by following formula. MELD = 3.78 [Ln serum bilirubin (mg/dL)] +11.2 [Ln INR] +9.57 [Ln serum creatinine (mg/dl)] +6.430 NR. Outcome of patients treatment was to record associated morbidity and mortality during follow-up period of one month. RESULTS: There were 156 (66.4%) male and 79 (33.6%) female cirrhotic patients. The mean age was 47.8 ±8.7 years. Out of 235 patients of liver cirrhosis, 47 (20.0%) expired during the hospital stay, while 188 (80.0%) patients survived and discharged from the hospital. Most of the cirrhotic patients were experienced with MELD score 18-20, i.e. 144 (61.3%) followed by 70 (29.8%) in 21-25 and 21 (8.9%) had the range of 26-30. In-hospital mortality rate was statistically insignificant (p>0.05) with respect to MELD scores. Probability of survival was 0.80. CONCLUSION: Liver cirrhosis with MELD score >18 and variceal bleeding is highly prevalent in young adult patients, more likely in male patients having duration of disease since >1 year to 3 years such that every 1 of 5 patients expired during the hospital stay. Probability of survival was 80%.
