Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate.
BACKGROUND
bleeding from gastric varices is a life-threatening complication of portal hypertension. Fundal and isolated gastric varices are at high risk for variceal bleeding. In this study, we report our experience with n-butyl-2-cyanoacrylate (BC) in patients with large gastric varices.


METHODS
twenty-nine patients (15 male, 14 female) with large fundal varices (active bleed, 5; passive bleed after eradication of esophageal varices, 13; unbled fundal varices with red color sign, 11) underwent endoscopic sclerotherapy with BC. Cirrhosis was present in 13 patients; extrahepatic portal venous obstruction, in 13; and noncirrhotic portal fibrosis, in 3. N-Butyl-2-cyanoacrylate after mixing with lipiodol (1:1) was given to the initial 10 patients and was given in undiluted form to the remaining patients, followed by injection of 0.7 mL of distilled water to rinse the injection catheter. One to three injections (0.5-1 mL) were given until all gastric varices became hard. All patients were on long-term endoscopic sclerotherapy or variceal ligation programs for eradication of esophageal varices.


RESULTS
acute variceal bleeding was controlled in all five patients with BC injections. Eradication of gastric varices was achieved in 27 (93.1%) patients (20 patients in 1 session, 4 patients in 2, and 3 patients in 3-6). Rebleeding occurred in three (10.3%) patients who responded to repeat BC injections. Complications related to the procedure occurred in two (6.9%) patients. In one patient, the needle became impacted into the tissue adhesive. This patient died 5 days later because of massive upper gastrointestinal bleeding. In the other patient, there was distal embolization.


CONCLUSIONS
sclerotherapy of gastric varices with BC is a safe and an effective treatment for control of bleeding and eradication. The needle should be withdrawn immediately after the BC injection to prevent its impaction into the tissue adhesive.
Dhiman
Radha K
RK
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. rkpsdhiman@hotmail.com
Chawla
Yogesh
Y
Taneja
Sameer
S
Biswas
Rakesh
R
Sharma
Tilak R
TR
Dilawari
Jang B
JB
D000293:Adolescent; D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000031:analogs & derivatives*; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015911:Sclerotherapy / Q000379:methods*; D014014:Tissue Adhesives / Q000008:administration & dosage*
D014014:Tissue Adhesives; D007459:Iodized Oil; D004659:Enbucrilate