Enbucrilate for gastric varices: extended experience in 92 patients.
OBJECTIVE
We assessed N-2-butyl-cyanoacrylate (enbucrilate) in 92 patients with gastric variceal bleeding under an FDA-approved investigation. These results extend our prior report of the first 44 patients.


METHODS
Injection was performed with enbucrilate and ethiodol (1:1). Eighty patients had portal hypertension and 12 had splenic vein thrombosis.


RESULTS
In the portal hypertensive group, re-bleeding from gastric varices was seen in 4 of 80 (5%) from 0 to 72 h, 5 of 76 (6.5%) from > 72 h to 3 months and 9 of 51 (17%) from > 3 months to 1 year. Re-bleeding and survival were significantly related to the Child-Pugh class. In the splenic vein thrombosis group (n = 12), there was early rebleeding in 2 (17%) patients from 0 to 72 h, 1 (8%) from > 72 h to 3 months and none in the chronic phase (> 3 months to 1 year) although 1-year survival in this group was only 6 (50%) due to the underlying malignancy in most. Serious embolization was suspected in 2 patients (2%).


CONCLUSIONS
Enbucrilate offers an important intervention in gastric variceal bleeding which should be further studied in the US. A randomized trial is warranted to compare this intervention to radiological therapy.
Caldwell
S H
SH
GI/Hepatology Division, Digestive Health Center of Excellence, University of Virginia Medical Center, Charlottesville, VA 22908-0708, USA. shc5c@virginia.edu
Hespenheide
E E
EE
Greenwald
B D
BD
Northup
P G
PG
Patrie
J T
JT
D000328:Adult; D000359:Aftercare / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D004659:Enbucrilate / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D004998:Ethiodized Oil / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012449:Safety; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D004998:Ethiodized Oil; D004659:Enbucrilate