Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis

Gastrointest Endosc. 2009 Nov;70(5):881-7. doi: 10.1016/j.gie.2009.03.1169. Epub 2009 Jun 25.


Background and objectives: Gastric variceal hemorrhage treatment remains a difficult issue for clinicians. There is controversy regarding whether first-line treatment should be endoscopic therapy with cyanoacrylate glue or placement of a transjugular intrahepatic portosystemic shunt (TIPS). We compared these methods on the basis of rebleeding, survival, and complications. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: This was a retrospective cohort analysis of cirrhotic patients with gastric variceal hemorrhage treated with endoscopic cyanoacrylate therapy or TIPS placement at a single U.S. center from 1997 to 2007. The groups were compared for rebleeding at 72 hours, 3 months, and 1 year; survival rates at 3 months and 1 year; and acute and extended complications and morbidity.

Main outcome measurements and results: A total of 105 patients were included. There were no significant pretreatment differences between the 2 groups in age, sex, MELD (Model for End-Stage Liver Disease) score at the time of admission, or cause of liver disease. There were no significant differences in rebleeding at 72 hours, 3 months, and 1 year; survival at 3 months and 1 year; and aggregate long-term survival or acute complications. However, the TIPS group had a higher rate of long-term morbidity requiring hospitalization (41% with a TIPS and 1.6% in the cyanoacrylate arm, P < .0001).

Limitations: Retrospective and uncontrolled samples.

Conclusion: In patients with similar characteristics, cyanoacrylate therapy performed as well as a TIPS in controlling and preventing gastric variceal hemorrhage with no significant differences in survival. Patients receiving cyanoacrylate therapy experienced significantly less long-term morbidity related to therapy than patients who received a TIPS. Cyanoacrylate therapy appears to be safe and effective and compares favorably with TIPS therapy.

Publication types

  • Comparative Study

MeSH terms

  • Cyanoacrylates / administration & dosage*
  • Esophageal and Gastric Varices / complications*
  • Esophageal and Gastric Varices / therapy
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / therapy*
  • Hemostasis, Endoscopic / methods*
  • Hospitals, University*
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Portasystemic Shunt, Transjugular Intrahepatic / methods*
  • Retrospective Studies
  • Survival Rate / trends
  • Tissue Adhesives / administration & dosage*
  • Treatment Outcome
  • Virginia / epidemiology


  • Cyanoacrylates
  • Tissue Adhesives