title: Endoscopic cyanoacrylate injection for the treatment of gastric varices in children.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of N-butyl-2-cyanoacrylate in treating acute bleeding of gastric varices in children.
  
  
  METHODS
  The retrospective study included 21 children with 47 episodes of active gastric variceal bleeding who were treated by endoscopic injection of N-butyl-2-cyanoacrylate at Asan Medical Center Children's Hospital between August 2004 and December 2011. To reduce the risk of embolism, each injection consisted of 0.1-0.5 mL of 0.5 mL N-butyl-2-cyanoacrylate diluted with 0.5 or 0.8 mL Lipiodol. The primary outcome was incidence of hemostasis after variceal obliteration and the secondary outcome was complication of the procedure.
  
  
  RESULTS
  The 21 patients experienced 47 episodes of active gastric variceal bleeding, including rebleeding, for which they received a total of 52 cyanoacrylate injections. Following 42 bleeding episodes, hemostasis was achieved after one injection and following five bleeding episodes it was achieved after two injections. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL (range: 0.1-0.5 mL). Injection achieved hemostasis in 45 of 47 (95.7%) episodes of acute gastric variceal bleeding. Eleven patients (52.4%) developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 mo (range: 1.0-39.2 mo). No treatment-related complications such as distal embolism were noted with the exception of abdominal pain in one patient (4.8%). Among four mortalities, one patient died of variceal rebleeding.
  
  
  CONCLUSIONS
  Endoscopic variceal obliteration using a small volume of aliquots with repeated cyanoacrylate injection was an effective and safe option for the treatment of gastric varices in children.
authors.affiliation: Seak Hee Oh, Seung Jin Kim, Kang Won Rhee, Kyung Mo Kim, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
authors.forename: Seak Hee
authors.initials: SH
authors.lastname: Oh
authors.affiliation: Seak Hee Oh, Seung Jin Kim, Kang Won Rhee, Kyung Mo Kim, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
authors.forename: Seung Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Seak Hee Oh, Seung Jin Kim, Kang Won Rhee, Kyung Mo Kim, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
authors.forename: Kang Won
authors.initials: KW
authors.lastname: Rhee
authors.affiliation: Seak Hee Oh, Seung Jin Kim, Kang Won Rhee, Kyung Mo Kim, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
authors.forename: Kyung Mo
authors.initials: KM
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003487:Cyanoacrylates / Q000008:administration & dosage* / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D056910:Republic of Korea; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates
keywords: Children; Complication; Cyanoacrylate; Endoscopic variceal obliteration; Gastric varix