Outcomes of endoscopic gluing with cyanoacrylate glue of bleeding gastric varices

##plugins.themes.academic_pro.article.main##

Sondes Bizid
Riadh Bouali
Wafa Haddad
Ghanem Mohamed
Hatem Ben Abdallah
Nabil Abdelli

Abstract

Background: Gastric variceal bleeding is associated with significant morbidity and mortality. Its optimal treatment is not yet standardized and glue injection is the most often proposed treatment. The longterm results of this technique are still controversial.
aim: To assess the safety and efficacy of gastric variceal glue injection.
methods: Consecutive patients that underwent glue injection for gastric variceal bleeding in our endoscopy unit, from January 2000 to August 2011, were assessed.
results: Sixteen patients (9 men, 7 women) underwent cyanoacrylate glue injections for gastric variceal bleeding. The median follow-up period of 13 patients was 33 months (three were lost to follow-up). The average age was 60 years (3 - 80 years). All patients had stigmata of recent bleeding at endoscopy. Patients underwent an average of 2 gluing sessions (1-3 sessions). N-butyl-2-cyanoacrylate (Histoacryl ®) was the most often product used. No significant complications from cyanoacrylate injection were observed. No patient had a recurrent variceal bleeding. During the median follow-up period, two patients died.
Conclusion: Our data suggest that cyanoacrylate injection therapy is safe and effective for the prevention of short- and long-term bleeding from gastric varices.

Keywords:

Therapeutic endoscopy, Bleeding gastric varices, Cyanoacrylate glue, Portal hypertension

##plugins.themes.academic_pro.article.details##

References

  1. Kochar R, DuPont A W. Primary and secondary prophylaxis of gastric variceal bleeding. F1000 Med Rep 2010;2:26.
  2. Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M et al. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc 2007;66:402-7.
  3. Tripathi D, Ferguson JW, Therapondos G et al. Review article: recent advances in the management of bleeding gastric varices. Aliment Pharmacol Ther 2006;24:1-17.
  4. Kind R, Guglielmi A, Rodella L et al. Bucrylate treatment of bleeding gastric varices: 12 years' experience. Endoscopy 2000;32:512-9.
  5. Sarin SK, Lahoti D, Saxena SP et al. Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343-9.
  6. Yoshida H, Mamada Y, Taniai N et al. New methods for the management of gastric varices. WJ Gastroenterol 2006;12:5926- 31.
  7. Lesur G. Méthodes d'hémostase endoscopique : injection, coagulation, endoloop, clip, ligature élastique. e-mémoires de l'Académie Nationale de Chirurgie 2009;8:73-81.
  8. Samonakis DN, Triantos CK, Thalheimer U et al. Management of portal hypertension. Postgrad Med J 2004;80:634-41
  9. Chau TN, Patch D, Chan YW et al. “Salvage” transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology 1998;114:981-7.
  10. Maluf-Filho F, Sakai P, Ishioka S et al. Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled, and randomized study in Child-Pugh class C patients. Endoscopy 2001;33:421-7.
  11. Belletrutti PJ, Romagnuolo J, Hilsden RJ et al. Endoscopic management of gastric varices: Efficacy and outcomes of gluing with N-butyl-2-cyanoacrylate in a North American patient population. Can J Gastroenterol 2008;22:931-6.
  12. Iwase H, Maeda O, Shimada M, et al. Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding. Gastrointest Endosc 2001;53:585-92.
  13. Greenwald BD, Caldwell SH, Hespenheide EE et al. N-2- butylcyanoacrylate for bleeding gastric varices: A United States pilot study and cost analysis. Am J Gastroenterol 2003;98:1982- 8.
  14. Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology 2001;33:1060-4.
  15. Tan PC, Hou MC, Lin HC et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2- cyanoacrylate injection versus band ligation. Hepatology 2006;43:690-7.
  16. Sarin SK, Jain AK, Jain M et al. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol 2002;97:1010-5.
  17. Lo GH, Liang HL, Chen WC et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007;39:679-85.