Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

Abstract

Background Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding. Patients and Methods Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic treatment with a mixture of N-butyl-2-cyanoacrylate and Lipiodol TM . Ninety-one patients had cirrhosis and 6 had non-cirrhotic portal hypertension. Child-Pugh score at presentation for cirrhotic patients was A-12.1 %; B-53.8 %; C-34.1 % and median MELD score at admission was 13 (3-26). Successful hemostasis, rebleeding rate and complications were reviewed. Median time of follow up was 19 months (0.5-126). Results A median mixture volume of 1.5 mL (0.6 to 5 mL), in 1 to 8 injections, was used, with immediate hemostasis rate of 95.9 % and early rebleeding rate of 14.4 %. One or more complications occurred in 17.5 % and were associated with the use of Sengstaken-Blakemore tube before cyanoacrylate and very early rebleeding (p<0.05). Hospital mortality rate during initial bleeding episode was 9.3 %. Very early rebleeding was a strong and independent predictor for in-hospital mortality (p<0.001). Long-term mortality rate was 58.8 %, in most of the cases secondary to hepatic failure. Conclusion N-butyl-2-cyanoacrylate is a rapid, easy and highly effective modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Patients with very early rebleeding are at higher risk of death.

Management of bleeding gastric varices

“…Our study reinforces this claim, with a success rate of a single session of around 86%, which is comparable with 88-100% reported in the literature [2,4,14-20]. However, rebleeding rates have been reported to be between 16 and 35% in different studies [14][15][16][17][18][19][20]. To the best of our knowledge, this is the first study in which the outcomes following gastric variceal bleeding have been defined according to the Baveno V classification.…”

“…Rajoriya et al [15] reported a rebleeding rate of 16%, whereas in a study by Kang et al [20] 24% of the patients had rebleeding over a mean follow-up of B1 year, which is comparable with our study. The most common etiology of cirrhosis was chronic hepatitis C in our study, which is different from the western countries, where alcoholic cirrhosis is the major culprit [17,19]. However, the outcomes after histoacryl therapy have been similar in both parts of the world.…”

Clinical outcomes of gastric variceal obliteration usingN-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

“…Some studies have shown that the Child-Pugh score and associated HCC are risk factors for bleeding-related death [6,22,23], while another study reported that MELD score is a risk factor [24,25]; our study showed these relationships only on univariate analysis.…”

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

“…Th e fi ndings of our single-center retrospective study confi rm results reported by Rengstorff et al ( 6 ) and Monsanto et al ( 7 ), where the use of cyanoacrylate injection is very eff ective in controlling gastric variceal bleeding with an acceptable safety profi le. Studies from China, Portugal, and the United States have reported rebleeding rates in the range of 4% to 14.4% (6)(7)(8).…”