Endoscopic Cyanoacrylate Glue Injection in Management of Gastric Variceal Bleeding: US Tertiary Care Center Experience

Overview

Journal J Clin Exp Hepatol

Publisher Elsevier

Specialty Gastroenterology

Date 2018 Jun 13

PMID 29892182

Citations 4

Authors

Subhash Chandra

Adrian Holm

Rami G El Abiad

Henning Gerke

Affiliations

Soon will be listed here.

Abstract

Background/aims: Although endoscopic cyanoacrylate glue injection (ECGI) is recommended as first-line treatment for bleeding gastric varices (GV) there is still limited experience with this method in the US. Our aim was to analyze our 10-year experience of ECGI for treatment and prophylaxis of gastric variceal bleeding.

Methods: Records of patients undergoing ECGI of GV at our US tertiary care center between 6/2005 and 5/2015 were reviewed. Assessed outcomes were primary hemostasis, early rebleeding during hospitalization, recurrent bleeding during follow-up, eradication and recurrence of GV.

Results: Prophylactic ECGI was performed in 16 patients with large GV. Eradication was achieved in 15 (94%). During the median follow-up of 27 (IQR 7-47) months, 4 patients (26.6%) had variceal bleeding; all were treated successfully with ECGI. Fifty-seven patients underwent ECGI for GV bleeding. Primary hemostasis was achieved in all. Early rebleeding occurred in 2 (3.5%) and durable hemostasis could not be achieved. Follow-up beyond initial hospitalization was available in 41 patients. Bleeding recurred in 8 (19.5%) patients during a median follow-up of 12 (IQR, 3-51) months. Eradication of GV was achieved in 92% of patients but recurrent varices were found in 44% during a median follow up period of 33 months.

Conclusion: ECGI is effective in achieving hemostasis of bleeding GV and their eradication. Recurrent bleeding and recurrence of varices after complete obliteration however are not infrequent and continued surveillance is advisable.

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References

Chen J, Zeng X, Ma L, Huang X, Tseng Y, Wang J . Long-term efficacy of endoscopic ligation plus cyanoacrylate injection with or without sclerotherapy for variceal bleeding. J Dig Dis. 2016; 17(4):252-9. DOI: 10.1111/1751-2980.12331. View

Kochhar G, Navaneethan U, Hartman J, Parungao J, Lopez R, Gupta R . Comparative study of endoscopy vs. transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding. Gastroenterol Rep (Oxf). 2015; 3(1):75-82. PMC: 4324874. DOI: 10.1093/gastro/gou095. View

Qiao W, Ren Y, Bai Y, Liu S, Zhang Q, Zhi F . Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement. Medicine (Baltimore). 2015; 94(41):e1725. PMC: 4616775. DOI: 10.1097/MD.0000000000001725. View

Wu Q, Jiang H, Linghu E, Zhang L, Wang W, Zhang J . BRTO assisted endoscopic Histoacryl injection in treating gastric varices with gastrorenal shunt. Minim Invasive Ther Allied Technol. 2016; 25(6):337-344. DOI: 10.1080/13645706.2016.1192552. View

Banares R, Casado M, Camunez F, Matilla A, Echenagusia A, Simo G . Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding. Am J Gastroenterol. 1998; 93(1):75-9. DOI: 10.1111/j.1572-0241.1998.075_c.x. View

Rajoriya N, Forrest E, Gray J, Stuart R, Carter R, McKay C . Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding. QJM. 2010; 104(1):41-7. DOI: 10.1093/qjmed/hcq161. View

Sahagun G, Benner K, Saxon R, Barton R, Rabkin J, Keller F . Outcome of 100 patients after transjugular intrahepatic portosystemic shunt for variceal hemorrhage. Am J Gastroenterol. 1997; 92(9):1444-52. View

Hwang J, Shergill A, Acosta R, Chandrasekhara V, Chathadi K, Decker G . The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc. 2014; 80(2):221-7. DOI: 10.1016/j.gie.2013.07.023. View

Lo G, Liang H, Chen W, Chen M, Lai K, Hsu P . A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007; 39(8):679-85. DOI: 10.1055/s-2007-966591. View

10.

Tajiri T, Onda M, Yoshida H, Mamada Y, Taniai N, Yamashita K . The natural history of gastric varices. Hepatogastroenterology. 2002; 49(46):1180-2. View

11.

Koksal A, Kayacetin E, Torun S, Erkan V, Okten R . Splenic infarction after N-butyl-2-cyanoacrylate injection for gastric varices: why does it happen?. Surg Laparosc Endosc Percutan Tech. 2013; 23(5):e191-3. DOI: 10.1097/SLE.0b013e318272fd1e. View

12.

Choi M, Kim Y, Kim S, Lee Y, Seo Y, Kim M . The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding. Clin Mol Hepatol. 2013; 19(3):280-7. PMC: 3796678. DOI: 10.3350/cmh.2013.19.3.280. View

13.

Evrard S, Dumonceau J, Delhaye M, Golstein P, Deviere J, Le Moine O . Endoscopic histoacryl obliteration vs. propranolol in the prevention of esophagogastric variceal rebleeding: a randomized trial. Endoscopy. 2003; 35(9):729-35. DOI: 10.1055/s-2003-41581. View

14.

Bhat Y, Weilert F, Fredrick R, Kane S, Shah J, Hamerski C . EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video). Gastrointest Endosc. 2015; 83(6):1164-72. DOI: 10.1016/j.gie.2015.09.040. View

15.

Tripathi D, Stanley A, Hayes P, Patch D, Millson C, Mehrzad H . U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015; 64(11):1680-704. PMC: 4680175. DOI: 10.1136/gutjnl-2015-309262. View

16.

Mosli M, Aljudaibi B, Almadi M, Marotta P . The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre. Saudi J Gastroenterol. 2013; 19(4):152-9. PMC: 3745656. DOI: 10.4103/1319-3767.114508. View

17.

Rerknimitr R, Chanyaswad J, Kongkam P, Kullavanijaya P . Risk of bacteremia in bleeding and nonbleeding gastric varices after endoscopic injection of cyanoacrylate. Endoscopy. 2008; 40(8):644-9. DOI: 10.1055/s-2008-1077294. View

18.

Seewald S, Ang T, Imazu H, Naga M, Omar S, Groth S . A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos). Gastrointest Endosc. 2008; 68(3):447-54. DOI: 10.1016/j.gie.2008.02.050. View

19.

Procaccini N, Al-Osaimi A, Northup P, Argo C, Caldwell S . Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc. 2009; 70(5):881-7. DOI: 10.1016/j.gie.2009.03.1169. View

20.

Cheng L, Wang Z, Li C, Cai F, Huang Q, Linghu E . Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years' experience of 635 cases. Chin Med J (Engl). 2008; 120(23):2081-5. View