[Treatment of extra-esophageal variceal bleeding with cyanoacrylate].
OBJECTIVE
Endoscopic obliteration of bleeding extra-esophageal varices using N-butyl-2-cyanoacrylate (Histoacryl) has been validated by several authors. The aim of the present paper is to describe the intravariceal injection technique using cyanoacrylate and to present the own results and complications observed in conjunction with the haemostatic treatment.


METHODS
A total of 11 intravariceal injection treatments of N-butil-2-cyanoacrylate were performed in 8 patients (3 males, 5 females, mean age 65.5 years) with extra-esophageal variceal bleeding. In 7 cases the bleeding varices were located in the gastric fundus and in one case the varix was found in the duodenum. Variceal bleeders under subintensive care were treated early electively with 1:1 ratio cyanoacrylate-lipiodol intravariceal injection solutions. The injection needle was inserted trough a standard endoscope.


RESULTS
Early haemostasis was achieved in all patients (11/11) and no early rebleeding occurred. In one case because of repeated episodes of late recurrent bleedings 3 more injection treatments were performed. In another case several hours after the injection a transitional cerebral ischemic attack developed. Injection needle sticking occurred during one treatment. There was no mortality due to acute bleeding while two patients died because of hepatic failure during the follow up period.


CONCLUSIONS
Endoscopic injection of diluted cyanoacrylate and lipiodol appears to be an effective and safe treatment method of the extra-esophageal variceal bleeding. Injection treatment in an early elective fashion can be performed with the standard sclerotherapy equipment.
Pécsi
Gyula
G
Petz Aladár Megyei Oktató Kórház, I. Belgyógyászat-Gasztroenterológia, Gyor. pecsigyula@chello.hu
Kárász
Tibor
T
Rácz
István
I
D000368:Aged; D004386:Duodenum / Q000098:blood supply; D004659:Enbucrilate / Q000008:administration & dosage*; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D007459:Iodized Oil / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications / Q000628:therapy*
D012597:Sclerosing Solutions; D007459:Iodized Oil; D004659:Enbucrilate