[Long-term results of endoscopic histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices--a 10-year experience].
OBJECTIVE
Gastric variceal bleeding is an infrequent but serious complication of portal hypertension. Endoscopic injection of Histoacryl (N-butyl-2-cyanoacrylate) has been approved as an effective treatment for gastric variceal bleeding. The aim of this study was to evaluate the long-term efficacy and safety of the endoscopic injection of Histoacryl for the treatment of gastric varices.


METHODS
Between January 1994 and January 2005, eighty-five patients with gastric varices received endoscopic injections of Histoacryl. Among these 85 patients, 65 received the procedure within 1 week after gastric variceal bleeding, and 13 received as a prophylactic procedure. According to the Sarin classification, 32 patients were GOV1 and 53 were GOV2. Most of the varices were large (F2 or F3, 75 patients). The average volume of Histoacryl per each session was 1.43 ml. Among 85 patients, 72 patients were followed-up and the median duration was 24.5 months.


RESULTS
The rate of initial hemostasis was 98.6% and recurrent bleeding occurred in 29.2% (21 of 72). When rebleeding occurred, 76.2% was within 1 year after the initial injection. Treatment failure-related mortality rate was 1.4% (1 of 85). Twenty-seven patients died, mostly due to hepatocelluar carcinoma or liver failure. Two patients experienced pulmonary embolism and one experienced splenic infarction. They recovered without specific treatment. Rebleeding rate had a tendency to increase in patients with hepatocelluar carcinoma (p=0.051) and GOV2 (p=0.061).


CONCLUSIONS
Histoacryl injection therapy is a effective treatment method for gastric varices with high initial hemostasis rate and low major complications.
Joo
Hyun Soo
HS
Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
Jang
Jae Young
JY
Eun
Soo Hoon
SH
Kim
Sang Kyun
SK
Jung
In Seop
IS
Ryu
Chang Beom
CB
Kim
Young Seok
YS
Kim
Jin Oh
JO
Cho
Joo Young
JY
Kim
Yun Soo
YS
Lee
Joon Seong
JS
Lee
Moon Sung
MS
Shim
Chan Sup
CS
Kim
Boo Sung
BS
D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000737:chemistry / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D015996:Survival Rate
D012597:Sclerosing Solutions; D004659:Enbucrilate