A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans.
BACKGROUND
N-butyl cyanoacrylate injection has been shown to be effective and safe for the endoscopic treatment of gastric varices. N-butyl cyanoacrylate is not available in the United States, but use of a similar agent, 2-octyl cyanoacrylate, recently was approved for skin closure. This pilot study prospectively evaluated the efficacy and safety of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices.


METHODS
Twenty-five patients with large gastric fundal varices with either stigmata of recent hemorrhage, a history of bleeding, or high-risk varices underwent intravariceal injection of undiluted 2-octyl cyanoacrylate. The end points for this study were cessation of active bleeding, successful obliteration of visible varices, and prevention of bleeding.


RESULTS
Within 2 weeks of treatment, 52% of patients had a history of significant variceal bleeding, and 12% had active gastric variceal bleeding at the time of injection. The rate of immediate hemostasis was 100%. Gastric variceal bleeding recurred in 4% of patients (mean follow-up 11 months). The overall mortality rate was 12%; the bleeding-related mortality rate was 4%.


CONCLUSIONS
Injection of 2-octyl cyanoacrylate appears to be efficacious and safe for both prevention and control of gastric variceal hemorrhage. Larger studies are required to further establish the use of 2-octyl cyanoacrylate for treatment of gastric fundal varices.
Rengstorff
Daniel S
DS
Interventional Endoscopy Service, California Pacific Medical Center, San Francisco, California 94115, USA.
Binmoeller
Kenneth F
KF
D000368:Aged; D000369:Aged, 80 and over; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004621:Embolization, Therapeutic / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005748:Gastric Fundus; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015911:Sclerotherapy / Q000379:methods*; D014014:Tissue Adhesives / Q000008:administration & dosage*
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate