Sex and test verification bias. Impact on the diagnostic value of exercise echocardiography

This trial represents the Egyptian experience in cyanoacrylate injection for hemostasis of bleeding gastric varices. One hundred patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis were included. All patients presented with bleeding from gastric varices either fundal (80 patients) or inferior extension of esophageal varices (20 patients) were enrolled. Injection therapy was administered as the first active measure. No tamponade or drugs were used. Cyanoacrylate was mixed with lipid and injected through a hand-made probe. A mean of 3 (range 1-9) ampoules of cyanoacrylate were used per injection session. Bleeding stopped at the end of all sessions. Ten patients (12.5%) with fundal varices had rebleeding during the first 24 hours. Reinjection could control bleeding in 6 patients with a total success rate of 95%. Four patients were managed surgically. Fatal pulmonary embolism developed in one patient (1.25%) with fundal varix. Five more patients (6.25%) died from bleeding-related liver failure. In conclusion, injection of cyanoacrylate is highly satisfactory in controlling bleeding from both types of gastric varices.