Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration

J Gastroenterol Hepatol. 2009 Mar;24(3):372-8. doi: 10.1111/j.1440-1746.2008.05651.x. Epub 2008 Nov 20.


Background and aim: Our study aimed to evaluate the therapeutic results of endoscopic N-butyl-2-cyanoacrylate injection (EBC) and balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric variceal hemorrhage (GVH) and/or high-risk gastric varices (GV).

Methods: Twenty-seven patients with GVH and/or high-risk GV (>or= 5 mm in diameter, those with red spots, and a Child-Pugh grading of B or C liver cirrhosis) who were treated with either EBC or BRTO from April 2005 to December 2007 were included in our study.

Results: EBC or BRTO was initially used for the treatment of GVH in 14 and 13 patients, respectively. Technical success was achieved in all 14 patients (100%) initially treated with EBC, and 10 of 13 patients (76.9%) initially treated with BRTO. Significant rebleeding occurred in 10 patients (71.4%) of the EBC group, and two patients (15.4%) of BRTO group (P < 0.01). Five of six patients (83.3%) treated with rescue BRTO due to rebleeding after initial EBC achieved technical success, and all six patients who were treated with rescue BRTO had no rebleeding during the median follow up of 17 (range: 2-37) months. The cumulative survival rate of the EBC with the BRTO rescue group/BRTO group was significantly higher than the EBC group.

Conclusion: The therapeutic efficacies of EBC and BRTO for the treatment of active GVH and/or high-risk GV appeared to be similar. However, EBC might be associated with a higher rebleeding rate than BRTO. BRTO could be an effective rescue treatment for patients with GVH after initial treatment of EBC.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Balloon Occlusion* / adverse effects
  • Enbucrilate / administration & dosage*
  • Enbucrilate / adverse effects
  • Esophageal and Gastric Varices / etiology
  • Esophageal and Gastric Varices / mortality
  • Esophageal and Gastric Varices / pathology
  • Esophageal and Gastric Varices / therapy*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / pathology
  • Gastrointestinal Hemorrhage / therapy*
  • Gastroscopy* / adverse effects
  • Humans
  • Injections, Intralesional
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / therapy
  • Male
  • Middle Aged
  • Oleic Acids / administration & dosage*
  • Oleic Acids / adverse effects
  • Prospective Studies
  • Recurrence
  • Risk Assessment
  • Sclerosing Solutions / administration & dosage*
  • Sclerosing Solutions / adverse effects
  • Severity of Illness Index
  • Time Factors
  • Tissue Adhesives / administration & dosage*
  • Tissue Adhesives / adverse effects
  • Treatment Outcome


  • Oleic Acids
  • Sclerosing Solutions
  • Tissue Adhesives
  • Enbucrilate
  • ethanolamine oleate