Undiluted N-butyl cyanoacrylate is safe and effective for gastric variceal bleeding.
BACKGROUND
Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. N-butyl cyanoacrylate (NBC), mixed with lipiodol, has been shown to be effective in controlling bleeding, but is associated with the risk of distal embolization.


OBJECTIVE
To study the efficacy and safety of undiluted NBC in the management of gastric varices (GV).


METHODS
Prospective cohort study.


METHODS
Single tertiary care center.


METHODS
170 consecutive patients with GV.


METHODS
Standardized technique of undiluted NBC injection for management of GV.


METHODS
Achievement of initial hemostasis, rate of rebleeding, procedure-related complications, and mortality.


RESULTS
GV were identified in 170 patients, 87 of whom were treated with 261 injections of undiluted NBC. Among 46 patients with active bleeding of GV, initial hemostasis was achieved in 84.8%. Rebleeding was seen in 23.4% patients over a mean follow-up of 16 months. No case of clinical distal embolization was seen. Large GV size, fundal location, and large esophageal variceal size were predictive of GV bleed. The mortality was 8.8% for all patients with GV; 10.3% for patients with GV treated with NBC, and 7.2% for those with GV not treated with NBC. Child-Pugh status was the only predictor of mortality.


CONCLUSIONS
Only 1 intervention group.


CONCLUSIONS
Undiluted NBC is safe and effective in the management of gastric variceal bleeding.
Kumar
Ajay
A
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Singh
Siddharth
S
Madan
Kaushal
K
Garg
Pramod Kumar
PK
Acharya
Subrat Kumar
SK
D000328:Adult; D004659:Enbucrilate / Q000008:administration & dosage / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult
D004659:Enbucrilate