Endoscopic therapy with 2-octyl-cyanoacrylate for the treatment of gastric varices.
BACKGROUND
Gastric variceal bleeding is associated with significant morbidity and mortality and limited endoscopic therapeutic options.


OBJECTIVE
The aim of this study was to evaluate the short- and long-term efficacy and safety of endoscopic therapy with 2-octyl-cyanoacrylate in patients with gastric variceal bleeding.


METHODS
A single-center retrospective review of patients receiving endoscopic therapy for gastric variceal hemorrhage. Patient demographics, laboratory, and procedural data were collected. Patients were followed to death, liver transplantation, or last follow-up. Success rates were defined as immediate control of bleeding; early re-bleeding (1-7 days), short-term re-bleeding (1-12 weeks), overall survival, and serious procedure complications.


RESULTS
A total of 41 patients (39 with cirrhosis) underwent 54 cyanoacrylate injections during study period. Mean age was 57 and 73 % were males. Twenty-four (58.5 %) patients had failed or were deemed ineligible for transjugular intra-hepatic portosystemic shunt, and 5 % were done for primary prophylaxis. Immediate hemostasis was achieved in five active bleeders. During a median survival time of 117 days, early re-bleeding was seen in 1 (2.4 %), short-term re-bleeding in five patients (12 %), and varices were eradicated in 15 (46.8 %) patients on follow-up. Mean MELD score at the time of the first injection was 17.1 ± 7.8. Mean volume injected was 3.4 cc and median number of varices injected per session was one. Eight patients died during the long-term follow-up: metastatic cancer (2), infections (3), liver failure (1), and re-bleeding (2). There were no serious procedure-related complications.


CONCLUSIONS
Endoscopic cyanoacrylate therapy appears effective and safe for treatment of patients with bleeding from gastric varices or high-risk stigmata.
Department of Internal Medicine, University of Tennessee College of Medicine, Chattanooga, 979 East Third Street, Suite C-825, Chattanooga, TN, 37403, USA, Arslan.Kahloon@erlanger.org.
Arslan
A
Kahloon
Naga
N
Chalasani
John
J
DeWitt
Suthat
S
Liangpunsakul
Rakesh
R
Vinayek
Raj
R
Vuppalanchi
Marwan
M
Ghabril
Michael
M
Chiorean
D003487:Cyanoacrylates / Q000627:therapeutic use*; D058625:End Stage Liver Disease / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate