Long-term outcomes of acute gastric variceal bleeding in 48 patients following treatment with cyanoacrylate.
OBJECTIVE
(1) Study the effectiveness of intravariceal injection of n-butyl-2-cyanoacrylate to treat acute gastric variceal (GV) bleeding and (2) study the impact of the type of GV and hepatic function on endoscopic hemostasis and mortality outcomes.


METHODS
Fourty-eight patients with acute GV bleeding underwent intravariceal injection of n-butyl-2-cyanoacrylate and were followed until death or study conclusion (12-52 months).


RESULTS
Primary hemostasis (no re-bleeding within 48 h) was accomplished in 42 patients (87.5%). Appearance of the bleeding site at the time of initial endoscopy, grade of cirrhosis and location of GV were not significant predictors of immediate hemostasis. Early re-bleeding (48 h to 6 weeks) occurred in 20.5% of patients and late re-bleeding (beyond 6 weeks) in 20.5% of patients. While the Child-Pugh score was predictive of re-bleeding and mortality, the type of GV and stigmata at initial endoscopy were not significant predictors of re-bleeding and mortality. Over a mean follow-up of 18 months, mortality rates were 43.9% and bleeding was the commonest cause of death.


CONCLUSIONS
Endoscopic injection of n-butyl-2-cyanoacrylate is effective and safe for treating bleeding GV. Patients with poor hepatic function are at higher risk of re-bleeding and death after acute gastric variceal bleed.
Marques
Petruska
P
Department of Gastroenterology, Gastrointestinal Endoscopy Division, University of São Paulo School of Medicine, Sao Paulo, Brazil.
Maluf-Filho
Fauze
F
Kumar
Atul
A
Matuguma
Sergio E
SE
Sakai
Paulo
P
Ishioka
Shinichi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004659:Enbucrilate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016558:Hemostasis, Endoscopic; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D014014:Tissue Adhesives; D004659:Enbucrilate