Korean J Gastroenterol.  2007 May;49(5):320-326.

Long-term Results of Endoscopic Histoacryl(R) (N-butyl-2-cyanoacrylate) Injection for Treatment of Gastric Varices : A 10-year Experience

• Joo HS
• Jang JY
• Eun SH
• Kim SK
• Jung IS
• Ryu CB
• Kim YS
• Kim JO
• Cho JY
• Kim YS
• Lee JS
• Lee MS
• Shim CS
• Kim BS

Abstract

BACKGROUND/AIMS: Gastric variceal bleeding is an infrequent but serious complication of portal hypertension. Endoscopic injection of Histoacryl(R) (N-butyl-2-cyanoacrylate) has been approved as an effective treatment for gastric variceal bleeding. The aim of this study was to evaluate the long-term efficacy and safety of the endoscopic injection of Histoacryl(R) for the treatment of gastric varices. METHODS: Between January 1994 and January 2005, eighty-five patients with gastric varices received endoscopic injections of Histoacryl(R) . Among these 85 patients, 65 received the procedure within 1 week after gastric variceal bleeding, and 13 received as a prophylactic procedure. According to the Sarin classification, 32 patients were GOV1 and 53 were GOV2. Most of the varices were large (F2 or F3, 75 patients). The average volume of Histoacryl(R) per each session was 1.43 ml. Among 85 patients, 72 patients were followed-up and the median duration was 24.5 months. RESULTS: The rate of initial hemostasis was 98.6% and recurrent bleeding occurred in 29.2% (21 of 72). When rebleeding occurred, 76.2% was within 1 year after the initial injection. Treatment failure-related mortality rate was 1.4% (1 of 85). Twenty-seven patients died, mostly due to hepatocelluar carcinoma or liver failure. Two patients experienced pulmonary embolism and one experienced splenic infarction. They recovered without specific treatment. Rebleeding rate had a tendency to increase in patients with hepatocelluar carcinoma (p=0.051) and GOV2 (p=0.061). CONCLUSIONS: Histoacryl(R) injection therapy is a effective treatment method for gastric varices with high initial hemostasis rate and low major complications.

Keyword

Injection, Endoscopic; Histoacryl(R) (N-butyl-2-cyanoacrylate); Varices, Gastric

MeSH Terms

Adult
Aged
Enbucrilate/administration & dosage/*analogs & derivatives/chemistry/therapeutic
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/mortality/surgery/*therapy
Female
Gastrointestinal Hemorrhage/mortality/surgery/*therapy
Humans
Injections
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Sclerosing Solutions/administration & dosage/*therapeutic use
Severity of Illness Index
Survival Rate