Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

Abstract

AIM:To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV). METHODS:We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed. RESULTS:The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV-Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P < 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50). CONCLUSION:GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding. In hospital mortality of patients with bleeding GV is 6%.

Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

“…Because of its excellent efficacy, N-butyl-2-cyanoacrylate is considered to be the optimal endoscopic therapy for gastric variceal bleeding [14]. Indeed, a large number of case series have demonstrated that N-butyl-2-cyanoacrylate injection successfully controlled acute gastric varices, with overall success rates ranging between 70 % to 100 % [3][4][5][6][7][8][9][10]. Radiologic transjugular intrahepatic portosystemic shunt (TIPS) placement has also been used as a therapeutic modality in this setting.…”

“…Soehendra et al first reported in 1986 that bleeding from gastric varices could be controlled by intravariceal injection of the tissue adhesive agent butyl cyanoacrylate [2]. Since then, several authors have used different sclerosing agents to achieve hemostasis, but N-butyl-2-cyanoacrylate (Histoacryl™) is the only promising agent, achieving primary hemostasis in 70 % to 100 % of patients, with an early rebleeding rate ranging from 0 % to 23 % [3][4][5][6][7][8][9][10]. In fact, although sclerotherapy with 5 % ethanolamine oleate, absolute ethanol or 1 % polidocanol has been reported to control bleeding in about 66 % of patients, it has a rebleeding rate of 50 % and it is more effective in patients with gastroesophageal varices than with fundal varices [11].…”

Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

“…Sohendra et al [10] first reported in 1986 that bleeding from GV could be controlled by sclerotherapy using the tissue adhesive agent butyl cyanoacrylate. Since then several authors have used different sclerosing agents to achieve hemostasis in bleeding gastric varices, including N-butyl-2 cyanoacrylate (histoacryl) [11,12] , 2-octyl cyanoacrylate [13] , ethanolamine oleate injection [14] , gastric variceal banding [15] , thrombin [1] and sodium tetradecyl sulfate [16] . However, N-butyl 2 cyanoacrylate (NBC) is the only promising agent.…”

Embolie pulmonaire liée à la sclérose d’une varice gastrique hémorragique par le butyl-cyanoacrylate

“…Le risque hémorragique par rupture de varices gastriques est moins fréquent que celui de la rupture des varices oesophagiennes [2]. L'incidence du saignement est de 10-36 %, mais l'hémorragie est habituellement plus abondante et difficile à contrôler [6].…”

“…Depuis sa première description par Soehendra en 1986 [1], la sclérose endoscopique avec une colle biologique (butylcyanoacrylate) est largement utilisée dans le traitement des varices oesogastriques hémorragiques ; elle est considérée actuellement comme le traitement de choix pour l'oblitéra-tion des varices gastriques [2]. Cette technique a été associée à diverses complications transitoires : hyperthermies, dysphagies, brûlures rétrosternales [3].…”