Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial

Gut. 2010 Jun;59(6):729-35. doi: 10.1136/gut.2009.192039.


Background and aims: Bleeding from gastric varices is often severe and difficult to manage. Endoscopic injection of gastric varices with cyanoacrylate is effective in prevention of rebleeding. The efficacy of beta-blockers in secondary prophylaxis of gastric variceal bleed has not been well studied. A comparison of the efficacy of beta-blocker treatment and cyanoacrylate injection for the prevention of gastric variceal rebleeding was carried out.

Methods: Patients with gastro-oesophageal varices type 2 (GOV2) with eradicated oesophageal varices or isolated gastric varices type 1 (IGV1) who had bled from gastric varices were randomised to cyanoacrylate injection (n=33) or beta-blocker treatment (n=34). Baseline and follow-up upper gastrointestinal endoscopy and hepatic venous pressure gradient (HVPG) measurements were performed. Primary end points were gastric variceal rebleeding or death.

Results: The probability of gastric variceal rebleeding rate in the cyanoacrylate group was significantly lower than in the beta-blocker group (15% vs 55%, p=0.004) and the mortality rate was lower (3% vs 25%, p=0.026) during a median follow-up of 26 months. The median baseline and follow-up HVPG in the cyanoacrylate group were 15 (10-23) and 17 (11-24) mm Hg (p=0.001) and for the beta-blocker group 14 (11-24) and 13 (8-25) mm Hg (p=0.003). While no patient showed reduction of HVPG in the cyanoacrylate group, in the beta-blocker group 12 of 28 (42%) patients were responders, of which 5 (41% of responders) bled. On multivariate analysis, treatment method, portal hypertensive gastropathy and size of the gastric varix >20 mm independently correlated with gastric variceal rebleeding. Gastric variceal rebleeding independently correlated with mortality.

Conclusions: Cyanoacrylate injection is more effective than beta-blocker treatment for the prevention of gastric variceal rebleeding and improving survival.

Trial registration: ClinicalTrials.gov NCT00888784.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use*
  • Adult
  • Aged
  • Child
  • Cyanoacrylates / adverse effects
  • Cyanoacrylates / therapeutic use*
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods*
  • Endoscopy, Gastrointestinal / methods
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / pathology
  • Esophageal and Gastric Varices / physiopathology
  • Esophageal and Gastric Varices / therapy*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / physiopathology
  • Gastrointestinal Hemorrhage / prevention & control*
  • Hepatic Veins / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Propranolol / adverse effects
  • Propranolol / therapeutic use
  • Recurrence
  • Risk Factors
  • Survival Analysis
  • Tissue Adhesives / adverse effects
  • Tissue Adhesives / therapeutic use*
  • Treatment Outcome
  • Venous Pressure / physiology
  • Young Adult


  • Adrenergic beta-Antagonists
  • Cyanoacrylates
  • Tissue Adhesives
  • Propranolol

Associated data

  • ClinicalTrials.gov/NCT00888784