Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol

Shi, Bei; Wu, Wei; Zhu, Hui; Wu, Ying

doi:10.3748/wjg.14.3598

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…Our study adds to the body of literature documenting the utility of cyanoacrylate for gastric varices [8][9][10][11] . However, our study differs from some reports in that most of our patients had active bleeding varices at the time of endoscopy.…”

Section: Discussionmentioning

confidence: 75%

Efficacy, Complications and Clinical Outcomes of Endoscopic Sclerotherapy with N-Butyl-2-Cyanoacrylate for Bleeding Gastric Varices

Fry

Neumann

Olano

et al. 2008

Dig Dis

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Background: Bleeding gastric varices (BGV) are a severe complication of portal hypertension. Although the obliteration of gastric varices using cyanoacrylate has been shown effective to eradicate gastric varices, there are still few data available on its effectiveness for acutely BGV, cyanoacrylate-related complications and follow-up. Aims: To report on the feasibility, efficacy and outcomes of N-buytl-2-cyanoacrylate sclerotherapy in patients with BGV. Methods: This is a retrospective cohort study of consecutive patients who were evaluated for BGV at University of Magdeburg Medical Center. Data abstracted for analysis from the prospectively collected database included patient’s demographics, etiology of gastric varices, Child-Pugh score, effectiveness of endoscopic treatment, clinical and endoscopic follow-up. Immediate hemostasis was defined as visible and clinical arrest of bleeding. The following were considered as potential complications of the procedure: aspiration, fever, worsening hemorrhage due to the sclerotherapy and systemic embolization of cyanoacrylate. Results: 33 patients (17 F, 16 M; mean age 54 years, range 18–81) with BGV (29 had active bleeding and 4 had stigmata of recent bleeding) underwent endoscopic injections of N-butyl-2-cyanoacrylate for hemostasis over a 5-year period. Mean follow-up: 9 months (range: 1 month to 5 years). Initial hemostasis was achieved in 88%. Treatment-related complications occurred in 5 (15.1%), the most common being deep ulcerations, which also resulted in recurrent bleeding. One patient presented with distal cyanoacrylate embolization. During long-term follow-up, 6 patients died, 5 as a consequence of the underlying liver disease and 1 as a consequence of complications due to systemic cyanoacrylate embolization. Conclusions: N-butyl-2-cyanoacrylate sclerotherapy is highly effective for the treatment of BGV, with rare complications occurring both acutely and in the long term.

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Section: Discussionmentioning

confidence: 75%

Efficacy, Complications and Clinical Outcomes of Endoscopic Sclerotherapy with N-Butyl-2-Cyanoacrylate for Bleeding Gastric Varices

Fry

Neumann

Olano

et al. 2008

Dig Dis

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“…In our study, hemostatic control was achieved in 100% of CYA sclerosis caused by emergency bleeding. Previous studies such as Tantau et al [12] and Serón P [13] have shown that cyanoacrylate is not inferior to treatment with ligation of varicose veins and its results are equivalent to the use of TIPS (Transjugular intrahepatic portosystemic shunt) as shown in the study by Procaccini et al [14] , without the presence of technical problems such as development of portal vein thrombosis, and encephalopathy described with the use of TIPS (Transjugular intrahepatic portosystemic shunt). The advantages of cyanoacrylate sclerotherapy include direct bleeding control and evaluation, increased reliability, reduced equipment requirements, use of conventional supplies such as standard sclerotherapy needles, rapid bleeding control, and low probability of endoscope damage using the appropriate technique.…”

Section: Discussionmentioning

confidence: 85%

Sclerosis of Fundic Varices. Experience in a Reference Center in the South West of Colombia, 2011-2017

Maldonado

2019

Journal of Gastroenterology and Hepatology Research

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for this type of patients. This study was carried out to make known the demographic characteristics of patients with gastric varices with or without the presence of esophageal varices that were taken to cyanocrylate sclerotherapy (CYP). Endoscopic findings, outcomes and complications are described. Data used to evaluate the safety and efficacy of the procedure in the management of patients with or without active variceal bleeding. This observational descriptive retrospective cross-sectional study included patients with manifest portal hypertension with esophageal and fundic varices, a total of 132 sclerotherapy procedures with cyanoacrylate mixed with lipiodol. We included 132 records of sclerotherapy with CYA, with equal gender distribution. Esophageal varices were found in 90.2% (119 records). In 31 procedures the indication was emergency bleeding (23.5%), of these 7 had CP-A, 12 CP-B, 0 CP-C and 12 without data. Out of the 101 elective interventions, 34 had CP-A, 24 CP-B, 6 CP-C and 37 without data, with no significant differences between groups (p value = 0.1). Homeostasis was achieved in 100% of patients with active bleeding. Varice sclerosis was successful with a single puncture in 81.1%, two punctures in 13.6% and three or more in 5.3% of the procedures. There were no complications in any of the patients, nor damage in the equipment used. In conclusión Endoscopic obliteration of fundic varices with CYP was safe and effective in the treatment of upper gastric variceal bleeding, without clinical complications in the procedure or damage to the endoscopic equipment used.

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“…Furthermore, when treating patients with a catastrophic event such as gastric variceal bleeding, the endoscopist needs to take into consideration the higher benefit of stopping the bleeding in relation to the lower risk of complications. The hemostatic success of rates Histoacryl ranges from 55 to 90% [7][8][9][10][11][12][13][14][15][16][17][18][19]. Furthermore, it is important to emphasize that there are currently very few other options to treat patients with gastric variceal bleeding [23,24].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Therapy for Gastric Varices

Mönkemüller¹,

Fry²

2009

Frontiers of Gastrointestinal Research

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Gastric varices occur in about 20% of patients with portal hypertension. Although bleeding from gastric varices occurs less frequently than from esophageal varices, it is usually more severe and more difficult to treat. There are multiple treatment options for bleeding gastric varices including placement of the Sengstaken-Blakemore tube, endoscopic sclerotherapy, performing a transjugular intrahepatic portosystemic shunt (TIPSS) and balloon-occluded retrograde transvenous obliteration (B-RTO). However, B-RTO is only possible to perform in the presence of splenorenal shunts. The Sengstaken is a measure of last resort, not used by most experts anymore. TIPSS should mainly be used if there is chance for liver transplantation. Of the available endoscocpic options, injection of N-butyl-2-cyanoacrylate sclerotherapy is highly effective for the obliteration and treatment of active bleeding gastric varices. This article describes the endoscopic approach to gastric varices.

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Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol

Cited by 6 publications

References 17 publications

Efficacy, Complications and Clinical Outcomes of Endoscopic Sclerotherapy with N-Butyl-2-Cyanoacrylate for Bleeding Gastric Varices

Efficacy, Complications and Clinical Outcomes of Endoscopic Sclerotherapy with N-Butyl-2-Cyanoacrylate for Bleeding Gastric Varices

Sclerosis of Fundic Varices. Experience in a Reference Center in the South West of Colombia, 2011-2017

Endoscopic Therapy for Gastric Varices

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