{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T19:02:13Z","timestamp":1782327733523,"version":"3.54.5"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Variceal haemorrhage is a severe complication of liver disease with high mortality. Human recombinant thrombin has gained popularity in the management of variceal haemorrhage. We report on the use of thrombin for gastric and ectopic varices at a regional tertiary care centre. This was a retrospective observational study. Patients with portal hypertension who received endoscopic injection of recombinant thrombin were identified and data collected on haemostasis and rebleeding rates, complications and mortality. Patients were grouped by indication for thrombin injection: gastric\/oesophageal\/ectopic varices and endoscopic band ligation (EBL)-induced ulceration. 155 patients (96M\/59F, mean age 58.3 years) received endoscopic thrombin injection. Mean volume of thrombin injected at index endoscopy was 9.5 ml\/2375IU. Initial haemostasis was achieved in 144 patients (92.9%). Rebleeding occurred in a total of 53 patients (36.8%) divided as follows: early rebleeding (&lt;5 days from index endoscopy)\u201426 patients (18%); rebleeding within 30 days\u201442 patients (29.1%); delayed rebleeding (&gt; 30 days)\u201411 patients (7.6%). There was statistically significant difference in rate of initial haemostasis between Child-Pugh A\/B patients vs Child-Pugh C (p = 0.046). There was no significant difference in rebleeding rates between different indication groups (p = 0.78), by presence of cirrhosis or by Child-Pugh Score. All-cause mortality at 6 weeks was 18.7%; 1-year mortality 37.4% (median follow-up 48 months). There was no significant difference in mortality between groups (p = 0.37). No significant adverse events or complications were reported. Thrombin is effective and safe for gastric varices and other portal-hypertension-related bleeding including oesophageal varices, ulcers secondary to EBL and ectopic varices.<\/jats:p>","DOI":"10.3390\/jcm10040785","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T05:02:14Z","timestamp":1613451734000},"page":"785","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1476-9369","authenticated-orcid":false,"given":"Sarah-Louise","family":"Gillespie","sequence":"first","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh H16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma C.","family":"McAvoy","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh H16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana E.","family":"Yung","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh H16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6749-9254","authenticated-orcid":false,"given":"Alexander","family":"Robertson","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh H16 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8863-8778","authenticated-orcid":false,"given":"John N.","family":"Plevris","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh H16 4SA, UK"},{"name":"College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9YL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9660-8322","authenticated-orcid":false,"given":"Peter C.","family":"Hayes","sequence":"additional","affiliation":[{"name":"Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh H16 4SA, UK"},{"name":"College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9YL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/hep.1840160607","article-title":"Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients","volume":"16","author":"Sarin","year":"1992","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.3748\/wjg.v13.i8.1247","article-title":"Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding","volume":"13","author":"Mumtaz","year":"2007","journal-title":"WJG"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.4253\/wjge.v6.i5.168","article-title":"Update on gastric varices","volume":"6","author":"Triantafyllou","year":"2014","journal-title":"WJGE"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/0950-3528(92)90037-F","article-title":"Management of gastric varices","volume":"6","author":"Sarin","year":"1992","journal-title":"Bailli\u00e8res Clin. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1053\/jhep.2001.24116","article-title":"A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices","volume":"33","author":"Lo","year":"2001","journal-title":"Hepatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/00004836-200209000-00005","article-title":"Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate","volume":"35","author":"Dhiman","year":"2002","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1055\/s-2007-1005435","article-title":"Evaluation of Undiluted N-Butyl-2-Cyanoacrylate in the Endoscopic Treatment of Upper Gastrointestinal Tract Varices","volume":"28","author":"Piemontese","year":"1996","journal-title":"Endoscopy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1136\/gutjnl-2019-320221","article-title":"Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension","volume":"69","author":"Tripathi","year":"2020","journal-title":"Gut"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5912","DOI":"10.3748\/wjg.v18.i41.5912","article-title":"Human thrombin for the treatment of gastric and ectopic varices","volume":"18","author":"McAvoy","year":"2012","journal-title":"WJG"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/MEG.0000000000000119","article-title":"Outcomes of endoscopic human thrombin injection in the management of gastric varices","volume":"26","author":"Smith","year":"2014","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1023\/A:1026626212129","article-title":"Thrombin is effective in arresting bleeding from gastric variceal haemorrhage","volume":"44","author":"Przemioslo","year":"1999","journal-title":"Dig. Dis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1136\/gut.35.9.1287","article-title":"Thrombin--an effective treatment for gastric variceal haemorrhage","volume":"35","author":"Williams","year":"1994","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/bjs.1800600817","article-title":"Transection of the oesophagus for bleeding oesophageal varices","volume":"60","author":"Pugh","year":"1973","journal-title":"Br. J. Surg."},{"key":"ref_14","unstructured":"Alcorn, J.B. (2020, July 30). Important Policy Notice: Clerical Changes for Implementation of Adding Serum Sodium to the MELD Score [Internet], Available online: https:\/\/optn.transplant.hrsa.gov\/media\/1575\/policynotice_20151101.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.jhep.2015.05.022","article-title":"Expanding consensus in portal hypertension","volume":"63","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis","volume":"69","author":"Angeli","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1136\/gutjnl-2015-309262","article-title":"UK guidelines on the management of variceal haemorrhage in cirrhotic patients","volume":"64","author":"Tripathi","year":"2015","journal-title":"Gut"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1111\/j.1572-0241.2002.05622.x","article-title":"A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices","volume":"97","author":"Sarin","year":"2002","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1002\/hep.21145","article-title":"A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation","volume":"43","author":"Tan","year":"2006","journal-title":"Hepatology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1055\/s-2000-3817","article-title":"Bucrylate Treatment of Bleeding Gastric Varices: 12 Years\u2019 Experience","volume":"32","author":"Kind","year":"2000","journal-title":"Endoscopy"},{"key":"ref_21","first-page":"92","article-title":"Endoscopic obliterative therapy with n-butyl-2-cyanoacrylate for gastrointestinal varices. Gastroenterol","volume":"1","author":"Sato","year":"2016","journal-title":"Hepatol. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1067\/mge.2000.104976","article-title":"Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: Long-term efficacy and safety","volume":"52","author":"Huang","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.3748\/wjg.v17.i11.1494","article-title":"Long-term result of endoscopic Histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices","volume":"17","author":"Kang","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1067\/mge.2002.125104","article-title":"Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices","volume":"56","author":"Lee","year":"2002","journal-title":"Gastrointest. Endosc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1055\/s-2007-1001406","article-title":"Pulmonary, Cerebral and Coronary Emboli During Bucrylate Injection of Bleeding Fundic Varices","volume":"30","author":"Roersch","year":"1998","journal-title":"Endoscopy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7746","DOI":"10.3748\/wjg.v23.i43.7746","article-title":"Procedure-related complications in gastric variceal obturation with tissue glue","volume":"23","author":"Guo","year":"2017","journal-title":"WJG"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/j.1478-3231.2008.01961.x","article-title":"Stroke after injection of gastric varices","volume":"29","author":"Joshi","year":"2009","journal-title":"Liver Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/1751-2980.12351","article-title":"Cyanoacrylate therapy for the treatment of gastric varices: A new method: Cyanoacrylate in gastric varices","volume":"17","author":"Singh","year":"2016","journal-title":"J. Dig. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1001\/archsurg.1947.01230080213011","article-title":"Use Of Buffer Thrombin In The Treatment Of Gastric Hemorrhage: A Preliminary Report","volume":"55","author":"Daly","year":"1947","journal-title":"Arch Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.gie.2008.02.065","article-title":"The use of thrombin injections in the management of bleeding gastric varices: A single-center experience","volume":"68","author":"Ramesh","year":"2008","journal-title":"Gastrointest. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E664","DOI":"10.1055\/a-0599-0440","article-title":"EUS-guided thrombin injection for management of gastric fundal varices","volume":"6","author":"Frost","year":"2018","journal-title":"Endosc. Int. Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1111\/j.1572-0241.2002.05776.x","article-title":"Endoscopic use of human thrombin in bleeding gastric varices","volume":"97","author":"Yang","year":"2002","journal-title":"Am. J. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s12664-018-0877-2","article-title":"Role and safety of human thrombin injection for the treatment of bleeding gastric varices","volume":"37","author":"Jhajharia","year":"2018","journal-title":"Indian J. Gastroenterol."},{"key":"ref_34","first-page":"548","article-title":"A prospective, randomized trial of thrombin versus cyanoacrylate injection in the control of acute gastric variceal hemorrhage","volume":"14","author":"Lo","year":"2020","journal-title":"Endoscopy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6668","DOI":"10.3748\/wjg.v25.i45.6668","article-title":"Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding","volume":"25","author":"Tantai","year":"2019","journal-title":"WJG"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1053\/jhep.2003.50385","article-title":"Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators","volume":"38","year":"2003","journal-title":"Hepatology"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Petrasch, F., Grothaus, J., M\u00f6ssner, J., Schiefke, I., and Hoffmeister, A. (2010). Differences in bleeding behavior after endoscopic band ligation: A retrospective analysis. BMC Gastroenterol., 10.","DOI":"10.1186\/1471-230X-10-5"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e7157","DOI":"10.1097\/MD.0000000000007157","article-title":"Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies?","volume":"96","author":"Cho","year":"2017","journal-title":"Medicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.dld.2019.06.019","article-title":"Ulcer bleeding after band ligation of esophageal varices: Risk factors and prognosis","volume":"52","author":"Cachero","year":"2020","journal-title":"Dig. Liver Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1097\/MEG.0000000000000387","article-title":"Risk factors for band-induced ulcer bleeding after prophylactic and therapeutic endoscopic variceal band ligation","volume":"27","author":"Sinclair","year":"2015","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1002\/cld.95","article-title":"Ectopic varices: Ectopic Varices","volume":"1","author":"Sarin","year":"2012","journal-title":"Clin. Liver Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.4254\/wjh.v7.i12.1601","article-title":"Treatment of ectopic varices with portal hypertension","volume":"7","author":"Sato","year":"2015","journal-title":"World J. Hepatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/4\/785\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:24:41Z","timestamp":1760160281000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/4\/785"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,16]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["jcm10040785"],"URL":"https:\/\/doi.org\/10.3390\/jcm10040785","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,16]]}}}