Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review

Abstract

Histoacryl glue is used increasingly for the treatment of gastric and ectopic varices, and there is experience in its use for oesophageal varices. It is an effective treatment, yet numerous reports of complications have accumulated. This review of the literature describes the technique, explores circulatory and vascular consideration unique to portal hypertension and categorises the complications into: “Embolisation”, “local venous thrombosis”, “fistulisation and extravascular injection”, “ulceration, erosion and extrusion”, and “nidus of infection”. A case is then made for standardisation of the technique and the consent process.

Glue pulmonary embolism and pulmonary oedema as a rare complication after endovascular embolisation of oesophageal varices

“…Presentation varies from asymptomatic to death after massive pulmonary embolism and can start during endoscopy or show a delayed onset. Symptoms may resolve over the following days after conservative management 2 3…”

Endoscopic Ultrasound for the Hepatologist: A Comprehensive Review

“…37 However, the use of glue for variceal management requires multidisciplinary assessment and patients require prior evaluation for the presence or absence of a septal defect, as besides embolization to the pulmonary arteries, systemic embolism has been reported and even associated with fatalities. 39 Also, the risk of embolization increases with greater injection volumes. This is why balloon-occluded retrograde transvenous obliteration (BRTO) is being increasingly used since the presence of a splenorenal or gastrorenal shunt has been documented in the majority of patients with GVs, serving as the main route through which embolization could occur.…”

“…This is why balloon-occluded retrograde transvenous obliteration (BRTO) is being increasingly used since the presence of a splenorenal or gastrorenal shunt has been documented in the majority of patients with GVs, serving as the main route through which embolization could occur. 39 Another possibility to treat GVs under EUS guidance is by performing intravascular embolization using metal coils covered with synthetic fibers available from interventional radiology. They can be delivered into a GVs under EUS guidance by using standard 22-or 19-gauge needles used to perform fine needle aspiration (FNA).…”

Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future

“…CYA injection has been reported to achieve hemostasis in 80%–90% of bleeding cases, with low rates of re-bleeding [9]. …”