Role and safety of human thrombin injection for the treatment of bleeding gastric varices.

Background: Human thrombin appears to be a new effective tool in the armamentarium of management of bleeding gastric varices, but there are paucity of data on its use. Thus, we share our experience with human thrombin in the treatment of bleeding gastric varices.

Methods: It was a prospective interventional study conducted between September 2015 and December 2017. Patients with upper gastrointestinal bleeding from gastric varices were included, while patients with previous history of cyanoacrylate glue injection or band ligation were excluded.

Results: A total of 20 patients including 13 males (mean age 32.65 [18-52] years) presenting with gastric variceal bleeding requiring endoscopic injection of human thrombin were studied. The underlying diagnosis was cirrhosis in 8 patients, and extrahepatic portal vein thrombosis, noncirrhotic portal fibrosis, and chronic pancreatitis in 6, 4, and 2 patients, respectively. Isolated gastric varices were found in 6 patients while 14 patients had gastroesophageal varices (GOV) (GOV1-3, GOV2-11). Patients received 1 to 3 sessions (mean = 1.3) of thrombin with a mean total dose of 700 IU (range = 500-2000 IU). Mean follow up was 16.8 months (range 3-28 months). Hemostasis in the acute setting was successfully managed in all the 20 patients on initial presentation. On serial follow up, 4 out of 20 patients required repeat endoscopic session for gastric varices. No thrombin injection-related complication was recorded.

Conclusion: Endoscopic therapy with thrombin appears safe and effective in the management of bleeding gastric varices.