Acrylate glue injection for acutely bleeding oesophageal varices: A prospective cohort study.
BACKGROUND
Acrylate glue injection is seldom performed in patients with bleeding oesophageal varices.


OBJECTIVE
To assess efficacy and safety of acrylate glue injection in patients with bleeding oesophageal varices, as well as the impact of this technique on subsequent variceal ligation.


METHODS
Prospective study on 133 consecutive cirrhotic patients treated by intravariceal injection of undiluted N-butyl-2-cyanoacrylate into the bleeding varix. Outcome measures were initial haemostasis, recurrent bleeding, complications and mortality at 6 weeks.


RESULTS
52 patients were actively bleeding at endoscopy and 81 showed stigmata of recent haemorrhage. Initial haemostasis was achieved in 49/52 active bleeders (94.2% [95% CI 85.1-98.5]). Overall, early recurrent bleeding occurred in 7 patients (5.2% [95% CI 2.3-10.1]). No major procedure-related complication was recorded. At 6 weeks, death occurred in 11 patients, with an overall bleeding-related mortality of 8.2% [95% CI 5.8-15.3]. Mortality was higher in active (15.4% [95% CI 6.9-28.1]) than non-active bleeders (3.7% [95% CI 0.8-10.4], OR 4.7 [95% CI 1.05-28.7], p=0.02). Of those surviving the first bleeding episode, 112 patients subsequently underwent ligation. No technical difficulties were encountered in performing the banding procedure which was successfully completed in all cases.


CONCLUSIONS
Emergency injection of acrylate glue is safe and effective for the treatment of acute bleeding oesophageal varices and does not hamper subsequent variceal ligation.
Division of Gastroenterology, Hospital Maresca, Torre del Greco, Italy. cipollet@tin.it
L
L
Cipolletta
A
A
Zambelli
M A
MA
Bianco
F
F
De Grazia
C
C
Meucci
G
G
Lupinacci
R
R
Salerno
R
R
Piscopo
R
R
Marmo
L
L
Orsini
G
G
Rotondano
D000208:Acute Disease; D000368:Aged; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D015552:Injections, Intralesional; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome
D003487:Cyanoacrylates; D014014:Tissue Adhesives