title: Long-term efficacy and safety of N-butylcyanoacrylate in endoscopic treatment of gastric varices.
abstract: BACKGROUND
  Endoscopic glue (N-butyl-2-cyanoacrylate) injection has emerged as promising therapy for bleeding gastric varices (GV). We evaluated safety and long term efficacy of this technique in patients with portal hypertension and large bleeding GV.
  
  
  METHODS
  170 patients (mean age 40.9 +/- 14y; 132 male; 142 had cirrhosis, 40 Child A, 62 Child B, 40 Child C) underwent glue injection into GV (F3 140, F2 30; fundal 114) as emergency procedure for active bleeding in 62 and electively for prevention of rebleeding in 108. Glue was injected intra-variceally under endoscopic vision, 0.5-4 ml/aliquot, repeated at 3 weeks till varices were eradicated/solidified. The efficacy was assessed by hemostasis at 48 h, primary, secondary, definitive success and treatment failure.
  
  
  RESULTS
  The overall hemostasis rate at 48h was 82.3% (51/62). Follow up was available in 158 patients for mean of 30.7 + 17.2 months. Repeat injections were performed in 76. The mean number of injections were 1.9 +/- 1.0 (1-4); total volume was 2.5 +/- 1.7 ml/patient. The status of GVs at last follow up was: disappeared in 32 (22.6%); F1 solidified in 46 (32.3%); F2 solidified in 64 (45.0%). Bleeding recurred in 14.5% (23/158); 60% within 2 weeks of injection. The primary, secondary and definitive success rates were 85.4% (135/158), 4.4% (7/158) and 89.9% (142/158) respectively and treatment failure rate was 10% (16/158). No significant complications were noticed except for injection site ulceration in 32. Twenty patients died on follow up (9 died of uncontrolled bleeding, 11 died of liver failure).
  
  
  CONCLUSIONS
  Endoscopic glue injection into bleeding GVs was effective in achieving hemostasis in 82% with a definitive success rate of 90% and had a good safety profile on long-term follow up.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. gourdas@satryam.net.in
authors.forename: Gourdas
authors.initials: G
authors.lastname: Choudhuri
authors.forename: Kamal
authors.initials: K
authors.lastname: Chetri
authors.forename: Ganesh
authors.initials: G
authors.lastname: Bhat
authors.forename: George
authors.initials: G
authors.lastname: Alexander
authors.forename: Kshaunish
authors.initials: K
authors.lastname: Das
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Kanak
authors.initials: K
authors.lastname: Das
authors.forename: Pratibha
authors.initials: P
authors.lastname: Chandra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic / Q000009:adverse effects; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014014:Tissue Adhesives / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate