title: [N-butyl-2-cyanoacrylate for the treatment of gastric varices].
abstract: OBJECTIVE
  To evaluate the success of the treatment with cyanoacrylate in primary hemostasis, rebleeding, and gastric varices eradication.
  
  
  METHODS
  In this retrospective study 65 patients with gastric varices treated with N-butyl-2-cyanoacrylate (Histoacryl) were included from January 1999 to January 2008. We used a solution of 0,5 mL of cyanoacrylate and 0.9 mL of lipiodol, utilizing an average of 3.46 mL of this mixture per session (range 1 to 6 mL). Sclerosing needles of 21 gauge were used. Patients were sedated. Data were analyzed using a chi-squared test.
  
  
  RESULTS
  Sixty-five patients were included, 42 men and 23 women with an average age of 53.8 years (range 18 to 76 years). The etiology of the portal hypertension (PH) was cirrhosis in 52 patients (80%), prehepatic PH in 7 (10.8%), and segmentary PH in 3 (4.6%), and non-classified in 3 (4.6%). Cirrhotic patients were classified as Child A in 21 cases, Child B in 25 and Child C in 6. According to the Sarin classification, 7 patients had gastric-oesophageal varices (GOV) type 1, 32 GOV2, 8 GOV1 and 2, and 8 isolated gastric varices (IGV) type 1. Fifty-six patients (86%) presented active bleeding or stigmata of recent bleeding at time of initial endoscopy. Primary hemostasis was achieved in 50 of them (89%) and the remaining 6 required a second session. Eleven patients presented rebleeding within the following 6 weeks and were again treated with cyanoacrylate. Hemostasis was achieved in 8 of them, 2 were referred for surgical management, and 1 received endovascular treatment. Follow-up was able in 53 patients for an average period of 11 months (range 1 to 81 months). During this period, 7 patients presented an episode ofrebleeding and were treated with cyanoacrylate, achieving hemostasis. Eradication of varices was documented on 21 patients (39.6%). The global rate of rebleeding was 37%. One patient developed splenic vein thrombosis as a major complication of treatment.
  
  
  CONCLUSIONS
  Definitive hemostasis was achieved in 94.6% of patients, with primary hemostasis in 89%. The global rate of rebleeding was 37% and the rate of major complications associated with treatment 0.6%. Eradication of gastric varices was achieved in 35.8% of cases. As these data show, it can be concluded that butyl-cyanoacrylate constitutes an effective method for the treatment of gastric variceal bleeding.
authors.affiliation: Servicio de Gastroenterología, Hospital San Martín, La Plata, Provincia de Buenos Aires, Argentina. ivanmosca2002@yahoo.com.ar
authors.forename: Iván
authors.initials: I
authors.lastname: Mosca
authors.forename: Regina
authors.initials: R
authors.lastname: Ligorría
authors.forename: Francisco
authors.initials: F
authors.lastname: Tufare
authors.forename: Augusto
authors.initials: A
authors.lastname: Villaverde
authors.forename: Fernando
authors.initials: F
authors.lastname: Baldoni
authors.forename: Horacio
authors.initials: H
authors.lastname: Martínez
authors.forename: Néstor
authors.initials: N
authors.lastname: Chopita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D004659:Enbucrilate