Endoscopic Cyanoacrylate Therapy Versus TIPS for Gastric Variceal Hemorrhage, a Single U.S. Center Analysis

Objective: Optimal treatment of gastric variceal hemorrhage remains controversial whether the preferred first line treatment should be endoscopic with cyanoacrylate glue or transjugular intrahepatic portosystemic shunt (TIPS). We sought to compare these two methods on the basis of rebleeding, survival, and complications. Methods: We performed a retrospective, cohort analysis on cirrhotic patients with gastric variceal hemorrhage treated at a single US center with either endoscopic cyanoacrylate therapy or TIPS from 1997-2007. The groups were compared for rebleeding at 72 hours, 3 months, and 12 months; survival rates at 3 months and 1 year; aggregate long-term survival; and acute and extended complications. Results: A total of 106 patients (61 in the cyanoacrylate arm, 44 in the TIPS arm) were included. There were no significant pre-treatment differences between the two groups in age, sex, MELD score at time ofadmission (prior to treatment), or etiology of liver disease. There were no significant differences between the groups in rates of rebleeding at 72 hours, 3 months, and one year, rates of survival at 3 months and one year, aggregate long term survival (measured in days survived per month followed) or acute complications. However, the TIPS group had a 20 fold higher rate of extended complications requiring hospitalization (41 0n the TIPS and 1.6 0n the cyanoacrylate arm, p=