title: Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience.
abstract: BACKGROUND
  Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding.
  
  
  METHODS
  Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic treatment with a mixture of N-butyl-2-cyanoacrylate and Lipiodol(TM). Ninety-one patients had cirrhosis and 6 had non-cirrhotic portal hypertension. Child-Pugh score at presentation for cirrhotic patients was A-12.1 %; B-53.8 %; C-34.1 % and median MELD score at admission was 13 (3-26). Successful hemostasis, rebleeding rate and complications were reviewed. Median time of follow up was 19 months (0.5-126).
  
  
  RESULTS
  A median mixture volume of 1.5 mL (0.6 to 5 mL), in 1 to 8 injections, was used, with immediate hemostasis rate of 95.9 % and early rebleeding rate of 14.4 %. One or more complications occurred in 17.5 % and were associated with the use of Sengstaken-Blakemore tube before cyanoacrylate and very early rebleeding (p < 0.05). Hospital mortality rate during initial bleeding episode was 9.3 %. Very early rebleeding was a strong and independent predictor for in-hospital mortality (p < 0.001). Long-term mortality rate was 58.8 %, in most of the cases secondary to hepatic failure.
  
  
  CONCLUSIONS
  N-butyl-2-cyanoacrylate is a rapid, easy and highly effective modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Patients with very early rebleeding are at higher risk of death.
authors: Gastroenterology Department, Coimbra University Hospital, Praceta Mota Pinto, 3000-075 Coimbra, Portugal. pedromonsanto@gmail.com
authors: Pedro
authors: P
authors: Monsanto
authors: Nuno
authors: N
authors: Almeida
authors: Albano
authors: A
authors: Rosa
authors: Fernanda
authors: F
authors: Maçôas
authors: Clotilde
authors: C
authors: Lérias
authors: Francisco
authors: F
authors: Portela
authors: Pedro
authors: P
authors: Amaro
authors: Manuela
authors: M
authors: Ferreira
authors: Hermano
authors: H
authors: Gouveia
authors: Carlos
authors: C
authors: Sofia
mesh_terms: D004659:Enbucrilate / Q000008:administration & dosage*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D004659:Enbucrilate