Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Abstract

We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from January 1980 to December 2019 and including patients who had injection of NBCA for variceal GIB. Two independent reviewers extracted and evaluated the data from eligible studies. Exclusion criteria were sample size <5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. NBCA was injected during endoscopy in 42 studies and through a direct percutaneous approach for stomal varices in 1 study. The study’s endpoints were: Technical success, 30-day rebleeding, and 30-day overall and major complications. The estimated overall rates were computed with 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. In total, 43 studies with 3484 patients were included. The technical success rate was 94.1% (95% CI: 91.6–96.1%), the 30-day rebleeding rate was 24.2% (18.9–29.9%), and 30-day overall and major complications occurred in 15.9% (11.2–21.3%) and 5.3% (3.3–7.8%) of patients, respectively. For treating variceal GIB, NBCA injection is a safe and effective method that demonstrates high technical success rate and very low major complication rate.

Modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension: A case report

“…However, transjugular intrahepatic portosystemic shunt, balloon retrograde transvenous obliteration, endoscopic injection sclerotherapy (EIS) and endoscopic NBC injection were reported effective for patients who are not suitable or unwilling to choose surgery[ 11 ]. Although endoscopic NBC injection therapy has been proven minimally invasive and effective[ 12 ], conventional endoscopic NBC injections may also cause severe complications including renal or pulmonary thromboembolism, fever, severe pain caused by intraperitoneal injection, mucosal necrosis at the injection site and GI bleeding[ 13 ]. As reported in recent years, an EUS-guided hemostasis treatment, including injection of NBC or in combination with coils, injection of thrombin or absorbable gelatin sponge, and clip-assisted endoscopic NBC injection, demonstrated promising results in reducing complication risks[ 14 , 15 ].…”

NBCA-Lipiodol Mixture Embolization of Persistent Urine Leakage After Orthotopic Neobladder Formation: Techniques and Outcomes

“…In this study, we used the mixture of NBCA and lipiodol as embolization material to treat PUL occurring at the neobladder-urethral anastomosis site. This mixture component is widely verified in vascular embolization with good biocompatibility ( 14 , 18 ); however, it is not well-utilized in urologic diseases, including urinary fistula or leakage. Compared to NBCA, the mixture of NBCA and lipiodol undergoes faster polymerization and has characteristics of increased viscosity and interfacial tension, which allows the material to reach but not pass through the target ( 14 ).…”

“…Compared to NBCA, the mixture of NBCA and lipiodol undergoes faster polymerization and has characteristics of increased viscosity and interfacial tension, which allows the material to reach but not pass through the target ( 14 ). Furthermore, the radiopaque characteristics of lipiodol make it easy to approach through percutaneous radiologic intervention ( 18 ). Considering the above beneficial effects, we hypothesized that this material would successfully work for closure of the neobladder-urethral leakage tract via a minimally invasive percutaneous approach.…”

Efficacy and Safety of N-Butyl 2 Cyanoacrylate Injection for Treatment of Gastric Varices: A five year experience from a tertiary care hospital in Karachi, Pakistan

“…N-Butyl 2 Cyanoacrylate is an adhesive/glue, it polymerizes (solidifies from a liquid state) very quickly 6 . It is used for sclerotherapy of large esophageal or gastric varices, closure of skin wounds and in fixation of mesh for inguinal hernia surgery.…”

“…N-Butyl 2 Cyanoacrylate injection was performed using a GIF-HQ 190 or a GIFQ 180 endoscope (Olympus C, Tokyo, Japan) and 23-gauge disposable injection needle catheter (1650 mm in length). Each shot contained 1.0 cc N-Butyl 2 Cyanoacrylate and 1-1.5cc of Lipiodol 6 (Guerbet, Aulnay-sous-Bois, France). The endoscopic suction channel was flushed with lubricant before insertion of the catheter.…”