Clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt: a multicenter study

Abstract

Background The aim of this study was to evaluate the safety and efficacy of clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt. Methods Records were reviewed of patients with gastric varices and concomitant gastrorenal shunts who underwent clip-assisted endoscopic cyanoacrylate injection at three tertiary centers between April 2016 and October 2018. The assessed outcomes were technical success rate, eradication of gastric varices, cyanoacrylate embolization, and all-cause rebleeding. Results A total of 61 patients were analyzed. The procedure was successful in all patients (100 %). Gastric varices were eradicated in 30 of 33 patients (90.9 %) according to contrast-enhanced computed tomography re-examination within 1 month after the procedure. No symptoms or signs of cyanoacrylate embolization related to the procedure were observed. Four patients (6.6 %) were lost to follow-up. All-cause rebleeding occurred in 13/57 patients (22.8 %) during a median follow-up period of 225 days (interquartile range 114 – 507 days). Conclusions Clip-assisted endoscopic cyanoacrylate injection appeared to be a safe procedure that was convenient and efficacious in the treatment of gastric varices with concomitant gastrorenal shunt.

Safety and Efficacy of Modified BRTO-Assisted Endoscopic Cyanoacrylate Injection for the Treatment of Isolated Gastric Varices with Gastro-Renal Shunt

“…successfully treated a IGV pa-tient with a combined technique, in which the sclerosant was endoscopically injected into the IGV while the GRS was temporarily occluded by BRTO. Studies have found that titanium clips can be safely used along with tissue adhesive injection in the treatment of IGV complicated by GRS [26]. Since Levy et al first used coils to treat ectopic varices in 2008 [27].…”

Reply to Chaudhari

“…We would like to thank Chaudhari et al for their interest in our paper [1] and for taking the time to express their concerns. Acute gastrointestinal bleeding occurred in only four patients, therefore, yielding a hemostasis rate of 100 %.…”

Ligation-occluded endoscopic injection sclerotherapy: a novel retrograde strategy for gastroesophageal varices obliteration

“…2 a). In this way, the role of the rubber band was similar to that of a dilated balloon in balloon-occluded retrograde transvenous obliteration and endoclip in clip-assisted gastric variceal obturation [3]. A combination of 7 mL foam sclerosant (1 % lauromacrogol: room air = 1:3), 1 mL tissue adhesive (N-butyl-2-cyanoacrylate), and 2.5 mL of normal saline was injected using a needle with a transparent catheter (23G; Boston Scientific) (▶ Video 1).…”