Endoscopic follow-up of cyanoacrylate obliteration of gastric varices

Abstract

Bleeding from gastric varices is a life-threatening condition. We report our experience with cyanoacrylate injection. Twenty three patients with portal hypertension and gastric varices underwent intra-variceal injection of a cyanoacrylate/lipiodol solution (1:1). Study endpoint was variceal obliteration. Mean follow-up was 25.3 months. Variceal obliteration was achieved in 87% of patients. Recurrence occurred in one patient (4.3%) and rebleeding in another case (4.3%). Mild abdominal pain was described in 13% of patients. Overall mortality was 21.7% and rebleeding related mortality rate was 4.3%. Our results confirm that cyanoacrylate injection is effective and safe to eradicate gastric varices.

Effect of endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric varices: A single center experience

“…Most studies on the use of cyanoacrylate in the setting of gastric variceal bleeding are retrospective, and only a few randomized prospective studies have been conducted (Table 3). 5,6,11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In comparison with EVL, cyanoacrylate was found to be more effective and safer. 5 Lee et al 13 performed a endoscopic ultrasound (EUS)-guided cyanoacrylate injection repeated every 2 weeks with the aim of eradicating gastric varices.…”

“…In previous studies, variceal obliteration was generally assessed by blunt palpation with a catheter, 15,20,27 although some investigators preferred to use EUS to look for evidence of residual gastric varices, in which case additional injections of cyanoacrylate were performed. 13,18 In the presence of concomitant esophageal varices, EVL was performed 3-4 weeks after gastric variceal obliteration was achieved.…”

“…Kim et al observed that if gastric variceal bleeding was left untreated it was associated with a mortality rate of 35% over a median of 15 months, 29 and rebleeding rates of 4-36.3%, while no-variceal causes, such as from portal gastropathy, diverticulae or undetermined causes, were associated with rebleeding rates ranging from 2.1-16%. [18][19][20]23 Furthermore, mortality directly due to gastric variceal bleeding was reported in the range of 0-18.5%, while other causes had a mortality rate of 6.1-29.9%. 5,11,15,[17][18][19][20][21][22][23]27 It may seem that over the long-term death rate in this group of patients is more often than not due to non-variceal causes.…”

“…[18][19][20]23 Furthermore, mortality directly due to gastric variceal bleeding was reported in the range of 0-18.5%, while other causes had a mortality rate of 6.1-29.9%. 5,11,15,[17][18][19][20][21][22][23]27 It may seem that over the long-term death rate in this group of patients is more often than not due to non-variceal causes. 13,15,19,[22][23][24] Moreover, long term follow up increases the chances of observing a rebleeding episode.…”

Safety and Efficacy of Eus-Guided Coil Plus Cyanoacrylate Versus Conventional Cyanoacrylate Technique in the Treatment of Gastric Varices: A Randomized Controlled Trial

“…Despite being less common than esophageal varices, gastric varices affect approximately 20% of patients with portal hypertension. Gastric varices can lead to more severe bleeding, which can be difficult to control, and present higher re-bleeding rates, which can range from 34%-89% (1,2) .…”