Safety and efficacy of 2-octyl-cyanoacrylate in the management of patients with gastric and duodenal varices who are not candidates for transjugular intrahepatic portosystemic shunts.
Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension and cirrhosis. Options are limited for patients who are not candidates for transjugular intrahepatic portosystemic shunts (TIPS). Cyanoacrylate injections have been reported to be efficacious in previous case series. The aim of this retrospective study was to report our single-center experience with the safety and efficacy of 2-octyl-cyanoacrylate in patients who were not TIPS candidates. Electronic medical records were reviewed for 16 patients who underwent a total of 18 esophagogastroduodenoscopies for acute gastric or duodenal variceal bleeding and secondary prophylaxis of gastric varices; 14 patients had cirrhosis with an average Model for End-Stage Liver Disease score of 16, and 2 patients had noncirrhotic portal hypertension. Primary endpoints of the study included early and delayed rebleeding rate, complications, and death or liver transplantation. The rebleeding rate (early or delayed) was 7%, and no complications were found. One death was reported (unrelated to the procedure). In conclusion, 2-octyl-cyanoacrylate is a safe and effective alternative for non-TIPS candidates who present with acute gastric variceal bleeding given its low rebleeding and complication rate.
Divisions of Gastroenterology (Lizardo-Sanchez, Burdick) and Hepatology (Trotter), Department of Internal Medicine, Baylor University Medical Center at Dallas.
Luis
L
Lizardo-Sanchez
Divisions of Gastroenterology (Lizardo-Sanchez, Burdick) and Hepatology (Trotter), Department of Internal Medicine, Baylor University Medical Center at Dallas.
James
J
Burdick
Divisions of Gastroenterology (Lizardo-Sanchez, Burdick) and Hepatology (Trotter), Department of Internal Medicine, Baylor University Medical Center at Dallas.
James F
JF
Trotter
Am J Gastroenterol. 2003 Dec;98(12):2688-93
14687818
Hepatology. 2010 Jan;51(1):306
19902484
Gastrointest Endosc. 2009 Nov;70(5):881-7
19559425
Clin Gastroenterol Hepatol. 2014 Jun;12(6):919-28.e1; quiz e51-2
23899955
Indian J Gastroenterol. 2013 Jul;32(4):227-31
22766643
Am J Gastroenterol. 2002 Apr;97(4):1010-5
12003381
Gastrointest Endosc. 2004 Apr;59(4):553-8
15044898
Gut. 2010 Jun;59(6):729-35
20551457
Hepatology. 2001 May;33(5):1060-4
11343232