Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

Scand J Gastroenterol. 2014 Sep;49(9):1136-42. doi: 10.3109/00365521.2014.929171. Epub 2014 Jun 20.

Abstract

Objective: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events.

Material and methods: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated.

Results: Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent.

Conclusion: Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.

Keywords: Histoacryl; bleeding; endoscopic ultrasonography; gastric varices; injection.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Enbucrilate / administration & dosage*
  • Enbucrilate / adverse effects
  • Endoscopy, Gastrointestinal / adverse effects
  • Endosonography
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / diagnostic imaging
  • Esophageal and Gastric Varices / therapy*
  • Female
  • Gastrointestinal Hemorrhage / diagnostic imaging
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Injections, Intralesional
  • Male
  • Middle Aged
  • Sclerosing Solutions / administration & dosage*
  • Sclerosing Solutions / adverse effects
  • Sclerotherapy / adverse effects
  • Sclerotherapy / methods*
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Sclerosing Solutions
  • Enbucrilate