EUS-guided injection of cyanoacrylate for bleeding gastric varices

Lee, Yuk Tong; Chan, Francis K.L.; Ng, Enders K.; Leung, Vyl; Law, Kai Bo; Yung, Man Yee; Chung, S. C. S.; Sung, Joseph J.Y.

doi:10.1067/mge.2000.107911

Cited by 174 publications

(136 citation statements)

References 17 publications

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“…20,22 Endoscopic injection of tissue glue for gastric variceal bleeding was first reported in 1986 by Soehendra et al 12 Since then, this method has been adopted widely and proved to be effective in the hemostasis of gastric variceal bleeding. [23][24][25][26][27][28]30 NBC, a liquid monomer, undergoes rapid exothermic polymerization on contact with living tissues, and this property of the compound has been used to eradicate and treat GV. The relative efficacy of glue injection in the control of active gastric variceal bleed has been addressed in three randomized trials; it has been compared to sclerotherapy in one trial and variceal ligation in two.…”

Section: Discussionmentioning

confidence: 99%

“…The relative efficacy of glue injection in the control of active gastric variceal bleed has been addressed in three randomized trials; it has been compared to sclerotherapy in one trial and variceal ligation in two. 22,24 Two trials demonstrated better control of bleed with the use of glue injection as compared to sclerotherapy or variceal ligation (89% vs. 62% and 87% vs. 45%) 27 ; the third showed equivalent results as variceal ligation. 22 Rebleed was significantly lower with glue injection when compared to variceal ligation (31% vs. 54%) 22,28 and similar to sclerotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…8 It has been suggested that rebleed rates may be reduced with the use of endoscopic ultrasound guided glue injection. 24 Billi et al 27 conducted a 24-month follow up of 50 patients who underwent glue injections for gastric varices and reported that acute hemostasis was achieved in 92% of patients. Also Fuster et al 29 reported good results from glue use in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

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Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection

Sharma

Banka

Rawat

et al. 2013

Journal of Clinical and Experimental Hepatology

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Background: Gastric varices are found in patients with portal hypertension. Incidence of bleeding from gastric varices is relatively low, but tends to be more severe, and is associated with higher mortality than esophageal variceal bleeding. Aims and objectives: To compare the prevalence and types of gastric varices in cirrhosis versus extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. Methods: Eighty six patients presenting with bleeding from gastric varices between August 2010 and August 2011 were retrospectively analyzed. Results: Of 86 patients, 65% (n = 56) were cirrhotics and 35% (n = 30) had EHPVO. Distribution of types of gastric varices showed GOV1 in 14% (n = 8) of cirrhotics vs. 7% (n = 2) of EHPVO, GOV2 in 80% (n = 45) of cirrhotics vs. 53% (n = 16) of EHPVO, IGV1 in 40% (n = 12) of patients with EHPVO vs. 4% (n = 2) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 3.7 ± 2.58 ml over a median of 1 session (range: 1-8). The total volume of glue required was lower in cirrhotics (3.2 ± 2 ml vs. 4.7 ± 3.1 ml, p < 0.05) than in EHPVO patients. Twenty (36%) of cirrhotics required >1 sessions of glue injection as compared to 17 (57%) of EHPVO patients. Over mean follow up of 12 months, rebleeding (9% vs. 10%) and mortality (11% vs. 3%) were similar in patients with cirrhosis and EHPVO. Conclusions: In patients with bleeding from gastric varices, GOV2 is more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for gastric varix obturation. ( J CLIN EXP HEPATOL 2013;3:19-23)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection

Sharma

Banka

Rawat

et al. 2013

Journal of Clinical and Experimental Hepatology

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“…7 In another study evaluating the utility of EUS monitoring in cyanoacrylate (CYA) injection by EGD to obliterate GV, clinical outcomes were compared between 54 patients who underwent biweekly EUS monitoring and repeated CYA injection by EGD until complete GV obliteration and 47 patients who underwent "on-demand" CYA injection in response to new episode of GV bleeding. 8 While there was no difference in the rate of early (< 48 hours) rebleeding, the rebleeding rate ≥ 48 hours was significantly reduced in the group with EUS monitoring and repeated CYA injection (44.7% vs 18.5%, P = 0.0053). 8 Volumetric change in paraesophageal varices on EUS has also been correlated with response to nonselective beta-blocker and risk of EV recurrence.…”

mentioning

confidence: 90%

“…8 While there was no difference in the rate of early (< 48 hours) rebleeding, the rebleeding rate ≥ 48 hours was significantly reduced in the group with EUS monitoring and repeated CYA injection (44.7% vs 18.5%, P = 0.0053). 8 Volumetric change in paraesophageal varices on EUS has also been correlated with response to nonselective beta-blocker and risk of EV recurrence. In a randomized study of 66 patients who achieved EV eradication by EBL, the relation between volumetric change of paraesophageal varices detected by EUS and EV recurrence in patients with or without propranolol as secondary prophylaxis was evaluated.…”

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confidence: 90%

Endoscopic ultrasound-guided vascular intervention for portal hypertension

Tang

2017

Int J Gastrointest Interv

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A B S T R A C TAs endoscopic ultrasound (EUS) equipment improves, the diagnostic and therapeutic applications of EUS in patients with portal hypertension (pHTN) have been increasingly explored. Various EUS-guided vascular interventions for pHTN have been evaluated in human or animal studies. EUS has been shown to be useful in variceal and perforating feeding veins identification, prediction of variceal recurrence/rebleeding, and assessment of response to pharmacological therapy for pHTN. When compared to conventional endoscopic therapies, EUS-guided therapy for varices and/or perforating feeding veins can ensure intra-variceal delivery of injection therapy, allow real-time monitoring of variceal obliteration, and provide injection therapy under pure EUS guidance when the target varix is endoscopically obscured. While the feasibility of EUS-guided assessment of portal hemodynamics and creation of intrahepatic portosystemic shunt has been evaluated, further studies would be needed to assess the long term outcomes before routine application.

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