title: Cyanoacrylate glue for gastrointestinal bleeding.
abstract: OBJECTIVE
  Cyanoacrylate (CYA) therapy has become an important component of the therapeutic toolbox of the interventional endoscopists with direct endoscopic injection accepted as first-line therapy of gastric varices. However, its generalized use has been cautioned by its serious adverse event profile.
  
  
  RESULTS
  Endoscopic ultrasound guided therapy has several conceptual advantages over free-hand injection, particularly as it ensures intravascular delivery of therapy. This has allowed innovation with the use of vascular coils with or without CYA therapy, and very encouraging long-term results are now published showing reduced serious adverse events and low rebleeding rates.
  
  
  CONCLUSIONS
  Direct endoscopic ultrasound guided intravascular injection of CYA is gaining widespread acceptance and offers reduced complication rates and significantly lower rebleeding rates. Data are supportive of CYA use both for primary and secondary prophylaxis of gastric varices.
authors.affiliation: aUnit of Endoscopy, Department of Gastroenterology, Waikato Hospital, Hamilton, New Zealand bPaul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Weilert
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Binmoeller