A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices

Sarin, Shiv Kumar; Jain, Ajay K.; Jain, Monika; Gupta, Rajesh

doi:10.1111/j.1572-0241.2002.05622.x

Cited by 290 publications

(117 citation statements)

References 23 publications

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“…2). Cyanoacrylate tissue adhesives such as N-butyl-cyanoacrylate (histoacryl), isobutyl-2-cyanoacrylate, or 2-octyl cyanoacrylate are used 36,37,38,39. Histoacryl is a nontoxic blue dye that acts as a potent adhesive when it makes contact with water in blood or tissues.…”

Section: Endoscopic Hemostasis Of Acute Variceal Bleedingmentioning

confidence: 99%

Management of Acute Variceal Bleeding

Kim

2014

Clin Endosc

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Acute variceal bleeding could be a fatal complication in patients with liver cirrhosis. In patients with decompensated liver cirrhosis accompanied by ascites or hepatic encephalopathy, acute variceal bleeding is associated with a high mortality rate. Therefore, timely endoscopic hemostasis and prevention of relapse of bleeding are most important. The treatment goals for acute variceal bleeding are to correct hypovolemia; achieve rapid hemostasis; and prevent early rebleeding, complications related to bleeding, and deterioration of liver function. If variceal bleeding is suspected, treatment with vasopressors and antibiotics should be initiated immediately on arrival to the hospital. Furthermore, to obtain hemodynamic stability, the hemoglobin level should be maintained at >8 g/dL, systolic blood pressure >90 to 100 mm Hg, heart rate <100/min, and the central venous pressure from 1 to 5 mm Hg. When the patient becomes hemodynamically stable, hemostasis should be achieved by performing endoscopy as soon as possible. For esophageal variceal bleeding, endoscopic variceal ligation is usually performed, and for gastric variceal bleeding, endoscopic variceal obturation is performed primarily. If it is considered difficult to achieve hemostasis through endoscopy, salvage therapy may be carried out while keeping the patient hemodynamically stable.

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Section: Endoscopic Hemostasis Of Acute Variceal Bleedingmentioning

confidence: 99%

Management of Acute Variceal Bleeding

Kim

2014

Clin Endosc

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“…EIS for gastric varices, although resulting in significantly improved hemostasis when using N-butyl-2-cyanoacrylate compared with other sclerosants, can result in bleeding from the injection site and rebleeding from the rupture site [76,[83][84][85][86]. Pulmonary, cerebral and coronary emboli may occur during cyanoacrylate injection of gastric varices [87,88].…”

Section: Recommendationsmentioning

confidence: 99%

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients. Experts predominantly from the Asia-Pacific region were requested to identify the different aspects of primary prophylaxis and develop the consensus guidelines. The APASL Working Party on Portal Hypertension evaluated the various therapies that have been used for the prevention of first variceal bleeding. A 2-day meeting was held on January 12 and 13, 2007, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and were subsequently presented at the annual conference of the APASL at Kyoto, Japan, in March 2007.

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“…It is used first line in gastric and ectopic varices (for emergency haemostasis and secondary prophylaxis) and second line for oesophageal varices (where banding is not possible due to degraded oesophageal tissue or previous failed banding attempts). There is a solid evidence base to support the use of glue in gastric varices with numerous case series[1-8] and randomised controlled trials[9-13] indicating that efficacy of haemostasis is over 80%-90%. Data comparing gastric variceal glue injection with transjugular intrahepatic portosystemic stent shunt (TIPSS) is relatively scarce.…”

Section: Introductionmentioning

confidence: 99%

Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review

Al‐Hillawi¹,

Wong²,

Tritto³

et al. 2016

WJGS

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Histoacryl glue is used increasingly for the treatment of gastric and ectopic varices, and there is experience in its use for oesophageal varices. It is an effective treatment, yet numerous reports of complications have accumulated. This review of the literature describes the technique, explores circulatory and vascular consideration unique to portal hypertension and categorises the complications into: “Embolisation”, “local venous thrombosis”, “fistulisation and extravascular injection”, “ulceration, erosion and extrusion”, and “nidus of infection”. A case is then made for standardisation of the technique and the consent process.

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A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices

Abstract: Our results show that cyanoacrylate is more effective and achieves GV obliteration faster than injection sclerotherapy with alcohol. It also appears to be more useful in controlling acute GV bleeding, with less of a need for rescue surgery.

Cited by 290 publications

References 23 publications

Management of Acute Variceal Bleeding

Management of Acute Variceal Bleeding

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review

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