Clinical efficacy of endoscopic titanium clips combined with tissue glue in treatment of moderate-to-severe gastric fundus varices

Objective To evaluate the clinical efficacy of endoscopic titanium clips combined with tissue glue in the treatment of moderate-to-severe gastric fundus varices. Methods A retrospective analysis was conducted on 60 patients with moderate-to-severe gastric varices treated with endoscopic tissue glue for upper gastrointestinal bleeding at Hangzhou Xixi Hospital from February 1, 2013 to July 31, 2017. The patients were divided into either a monotherapy group (treatment with Polyguiol-Tissue Gum-Polyguiol) or a combination therapy group (treatment by Titanium clipcombined with Polyguiol-Tissue Gum-Polyguiol) with 30 cases each. The Chi-square test was used to compare the rate of recurrent bleeding, mortality, and incidence of ectopic embolism within 1 year after endoscopic treatment in the two groups, and the t-test was used to compare the time of recurrent bleeding in the two groups and the amount of tissue glue used. Results Compared with the monotherapy group, the amount of tissue glue used in the combination therapy group was significantly reduced [(1.73±1.01) ml vs (1.13±0.64) ml, t=-2.736, P=0.008). There was no significant difference between the combination therapy group and the monotherapy group in the rebleeding rates at 1, 3, 6, 9, and 12 months after treatment [3.3% (1/30) vs 13.3% (4/30); 10.0% (3/30) vs 26.7% (8/30); 23.3% (7/30) vs 36.7% (11/30); 33.3% (10/30) vs 50.0% (15/30); 36.7% (11/30) vs 53.3% (16/30)], rebleeding time [(5.69±3.28) min vs (4.59±3.49) min], or mortality (1/30 vs 4/30) (P>0.05 for all). Ectopic embolism was not found in either group. Conclusion Endoscopic tissue glue combined with titanium clips can reduce the amount of tissue glue used in patients with moderate-to-severe gastric varices. The time of rebleeding, rebleeding rate, rebleeding-related mortality, and the incidence of ectopic embolism do not increase in the combination therapy group. Therefore, endoscopic titanium clips combined with tissue glue therapy are a safe and effective method. Key words: Varicose veins, gastric fundus; Endoscopic tissue glue; Titanium clips; Rebleeding; Ectopic embolism