title: Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection.
abstract: OBJECTIVE
  Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events.
  
  
  METHODS
  We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated.
  
  
  RESULTS
  Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent.
  
  
  CONCLUSIONS
  Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.
authors.affiliation: Clinic of Gastroenterology and Hepatology, University Hospital of Zurich , Zurich , Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gubler
authors.forename: Peter
authors.initials: P
authors.lastname: Bauerfeind
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D004659:Enbucrilate
keywords: Histoacryl; bleeding; endoscopic ultrasonography; gastric varices; injection