Primary Prophylaxis of Cardio-fundal Varices: A Comparative Study

Background and study aims: Gastric varices (GV) are less frequent than esophageal varices (EV) and have a lower ‎risk of bleeding. However, they are more prone to serious bleeding, often requiring ‎more blood transfusions, and have a higher mortality rate. Our study assessed ‎the comparative effectiveness of three modalities: endoscopic cyanoacrylate injection, ‎non-selective beta-blockade and no primary prophylactic treatment‎‎‎. Patients and Method: Forty-eight cirrhotic patients with cardio-fundal varices were classified into three groups ‎of16 patients each: group I: cyanoacrylate injected patients, group II: propranolol ‎treated patients and group III: untreated patients. Upper gastrointestinal endoscopy was ‎performed to establish the variceal status and repeated at 6-month intervals for 24 ‎months to record of size of GV, appearance of EV, portal hypertensive Gastropathy ‎‎(PHG) and occurrence of gastric variceal bleeding. Mortality rate was also recorded‎‎‎.‎ Results: Gastric variceal bleeding and mortality rates in group I, II and III were 6.2% and ‎‎18.8%; 31.2% and 6.2%, 6.2% and 12.5% ( p= 0.194 and p= 0.761 respectively). All ‎patients in group I had obliterated GV. The percentage of patients with large GV ‎increased from 18.8 to 37.5% (p=0.055) in group II and from 25 to 56.2% (p=0.002) in ‎group III. During follow up, EV appeared in 25% of patients in group I, 6%in group II ‎and12% in group III (p=0.509)‎‎. Conclusion: No significant difference in occurrence of gastric variceal bleeding or mortality rates ‎among the three groups managed with cyanoacrylate injection, propranolol ‎administration and observation without treatment ‎‎.