title: Sclerotherapy for gastric fundal variceal bleeding: is complete obliteration possible without cyanoacrylate?
abstract: BACKGROUND
  Many studies have suggested that endoscopic obliteration using cyanoacrylate for bleeding gastric fundal varices is effective. However, serious complications by injection of cyanoacrylate into varices have also been reported.
  
  
  METHODS
  Thirty patients with bleeding gastric fundal varices underwent endoscopic injection sclerotherapy using 5% ethanolamine oleate under fluoroscopic guidance plus infusion of vasopressin and a transdermal nitroglycerin patch. The injection of 5% ethanolamine oleate was continued until it filled the varices and their feeder veins under fluoroscopic guidance. The injection needle was removed while thrombin glue was sprayed at the puncture site through the side hole of the injector needle to prevent bleeding from the puncture site.
  
  
  RESULTS
  Complete hemostasis was achieved in 28/30 patients (93.3%). The cumulative rebleeding rate after 1, 3 and 5 years was 13%, 19% and 19%, respectively. The 1-, 3-, and 5-year cumulative mortality rates were 31%, 54% and 59%, respectively. There was no complication related to infusion of vasopressin and sclerotherapy procedure.
  
  
  CONCLUSIONS
  The sclerotherapy method carried out using 5% ethanolamine oleate combined with infusion of vasopressin under fluoroscopic guidance might be a feasible method for obliteration of gastric fundal varices as an alternative to cyanoacrylate.
authors.affiliation: Third Department of Internal Medicine, Nara Medical University Hospital, Kashihara-shi, Nara, Japan.
authors.forename: Kuniyuki
authors.initials: K
authors.lastname: Kojima
authors.forename: Hiroo
authors.initials: H
authors.lastname: Imazu
authors.forename: Masahiko
authors.initials: M
authors.lastname: Matsumura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
authors.forename: Norie
authors.initials: N
authors.lastname: Umemoto
authors.forename: Hirohito
authors.initials: H
authors.lastname: Moriyasu
authors.forename: Toru
authors.initials: T
authors.lastname: Orihashi
authors.forename: Masanobu
authors.initials: M
authors.lastname: Uejima
authors.forename: Chie
authors.initials: C
authors.lastname: Morioka
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Komeda
authors.forename: Masato
authors.initials: M
authors.lastname: Uemura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshiji
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukui
mesh_terms: D000328:Adult; D000368:Aged; D003487:Cyanoacrylates / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005748:Gastric Fundus; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D009829:Oleic Acids / Q000627:therapeutic use; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014667:Vasopressins / Q000627:therapeutic use
chemical_list: D003487:Cyanoacrylates; D006490:Hemostatics; D009829:Oleic Acids; D012597:Sclerosing Solutions; D014667:Vasopressins; D005996:Nitroglycerin; C033343:ethanolamine oleate