Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed

Indian J Gastroenterol. 2018 Mar;37(2):153-159. doi: 10.1007/s12664-018-0844-y. Epub 2018 Apr 9.

Abstract

Background and aims: N-butyl-cyanoacrylate injection is recommended in bleeding/recently bled gastric varices. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. The aim of this study was to compare EUS-guided coil application combined with or without cyanoacrylate glue injection to injection alone in post-glue gastric variceal re-bleed.

Methods: A retrospective analysis of a prospectively maintained database was performed. Thirty patients who re-bled after cyanoacrylate injection and who had EUS-guided coil application to gastric varices were included. The comparison was done with data of 51 patients who had only repeat cyanoacrylate injection. Both groups had a follow up for 12 months. EUS-guided coil application was done under endosonographic guidance. A single coil was placed in 7, two coils in each of 13 patients, three in 5, four in 3, five in one, and 6 coils in one patient. In addition, cyanoacrylate glue injection was given in 15 patients. Eight patients had repeat EUS-guided coil application 1 month later. Re-bleed and mortality were assessed.

Results: Coilng: Six out of 30 (20%) patients re-bled during follow up of 9 to 365 days. Three out of 30 (10%) died. One patient died 9 days after the procedure due to acute respiratory distress syndrome, one died 4 months after the procedure due to a re-bleed and one 5 months after the procedure due to spontaneous bacterial peritonitis. Glue only: 26/51 (51%) re-bled during follow up of 45 to 365 days. EUS-guided coil application resulted in significantly less re-bleed than glue-only (Kaplan-Meir survival analysis with log-rank test, z = 5.4, p < 0.001). Two out of 51 (4%) died 59 and 186 days after the procedure.

Conclusion: EUS-guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.

Keywords: EUS-guided coil application; N-butyl-cyanoacrylate injection; Portal hypertension; Post-cyanoacrylate gastric variceal re-bleed.

Publication types

  • Comparative Study

MeSH terms

  • Adhesives / administration & dosage*
  • Adhesives / adverse effects
  • Adult
  • Aged
  • Enbucrilate / administration & dosage*
  • Enbucrilate / adverse effects
  • Endosonography*
  • Esophageal and Gastric Varices / etiology
  • Esophageal and Gastric Varices / therapy*
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Hemostasis, Endoscopic / methods*
  • Humans
  • Hypertension, Portal / complications
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Adhesives
  • Enbucrilate