الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Portal hypertension and consequent variceal hemorrhage is one of the most devastating complications of chronic liver disease and is the most common cause of mortality and morbidity in patients with cirrhosis.
Gastroesophageal varices is a major and dangerous complication of chronic liver disease. Bleeding from gastric varices has more severe bleeding and higher mortality than esophageal. Cyanoaccrylate injection of bleeding gastric varices is recommended, however prophylactic injection of gastric varices is debatable. The aim of this study was to evaluate prophylactic cyanoacrylate injection for gastric extension of esophageal varices type II with esophageal varices band ligation in comparison to esophageal band ligation with and without beta blocker.
Methods: This study was designed as a randomized controlled trial included 75 patients (3 groups) with risky or bleeding esopahageal varices with gastric extension type II. group I had gastric injection with cyanoacrylate combined with esophageal variceal band ligation (EBL) and beta blocker (BB), group II had EBL and BB, and group III had EBL. Follow up for end points which were re-bleeding, death, changes in gastric extension or 24 weeks.
Our Results showed that no significant difference among the 3 groups regarding baseline grade of esophageal varices, gastric extension size, or grade of portal hypertensive gastropathy . during the study, one patient withdrew consent after allocation and 2 patients missed or refused 2nd endoscopy.
During follow up period (Median 37.5 , Range 1-60 weeks), increase gastric extension size or risk signs of bleeding were significantly lower in group I (0, 0%) than group II (3, 12 %) and III (8, 32 %) (P < 0.001).
Frequency of bleeding was higher in group II (6, 24%) and group III (6, 24%) than group I (2, 8 %). Bleeding was associated with previous history of blood transfusion or upper GI bleeding, shrunken liver, higher INR, bilirubin, and MELD score, and large EV and gastric extension > 2 cm.
Only large gastric extension was the independent predictor of bleeding in multivariate analysis (P=0.03).
Decrease in grade of PHG was more in group I (6, 24%) and II (6, 24%) who are taking BB than group III (2, 8%), although the difference was not statistically significant.
Mortality rate was (0, 0%) in group I, (2, 8%) in group II and (1, 4 %) in group III . Overall mortality rate was 4.1% and 5.7/ 100 Person-Year.