Gastrointestinal Endoscopy
Volume 68, Issue 3 , Pages 447-454 , September 2008

A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos)

Received 7 September 2006 ,Accepted 11 February 2008.

References 

  1. Sarin SK, Lahoti D, Saxena SP, et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16:1343–1349
  2. Kiyosue H, Hiromu M, Matsumoto S, et al. Transcatheter obliteration of gastric varices, 1: anatomic classification. Radiographics. 2003;23:911–920
  3. Watanabe K, Kimura K, Matsutani S, et al. Portal haemodynamics in patients with gastric varices: a study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology. 1988;95:434–440
  4. Sanyal AJ, Freedman AM, Luketic VA, et al. The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology. 1997;112:889–898
  5. Akahoshi T, Hashizume M, Shimabukuro R, et al. Long-term results of endoscopic histoacryl injection sclerotherapy for gastric variceal bleeding: a 10 year experience. Surgery. 2002;131(1 Suppl):S176–S181
  6. Kojima K, Imazu H, Matsumura M, et al. Sclerotherapy for gastric fundal variceal bleeding: is complete obliteration possible without cyanoacrylate?. J Gastroenterol Hepatol. 2005;20:1701–1706
  7. Kuo MJ, Yeh HZ, Chen GH, et al. Improvement of tissue-adhesive obliteration of bleeding gastric varices using adjuvant hypertonic glucose injection: a prospective randomized trial. Endoscopy. 2007;39:487–491
  8. Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33:1060–1064
  9. Tan PC, Hou MC, Lin HC, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006;43:690–697
  10. Tripathi D, Therapondos G, Jackson E, et al. The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and hemodynamic correlations. Gut. 2002;51:270–274
  11. Ochs A. Transjugular intrahepatic portosystemic shunt. Dig Dis. 2005;23:56–64
  12. D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995;22:332–354
  13. Boyer TD. Transjugular intrahepatic portosystemic shunt: current status. Gastroenterology. 2003;124:1700–1710
  14. Sarfeh IJ, Rypins EB, Fardi M, et al. Clinical implications of portal haemodynamics after small-diameter portacaval H graft. Surgery. 1984;96:223–229
  15. Kitamoto M, Imamura M, Kamada K, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices with fundal hemorrhage. AJR Am J Roentgenol. 2002;178:1167–1174
  16. Matsumoto A, Hamamoto N, Nomura T, et al. Balloon-occluded retrograde transvenous obliteration of high risk gastric fundal varices. Am J Gastroenterol. 1999;94:643–649
  17. Shiba M, Higuchi K, Nakamura K, et al. Efficacy and safety of balloon-occluded endoscopic injection sclerothertapy as a prophylactic treatment for high-risk gastric fundal varices: a prospective, randomized comparative clinical trial. Gastrointest Endosc. 2002;56:522–528
  18. Huang YH, Yeh HZ, Chen GH, et al. Endoscopic treatment for bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety. Gastrointest Endosc. 2000;52:160–167
  19. Iwase H, Maeda O, Shimada M, et al. Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding. Gastrointest Endosc. 2001;53:585–592
  20. Evrard S, Dumonceau JM, Delhaye M, et al. Endoscopic histoacryl obliteration vs propranolol in the prevention of esophagogastric variceal rebleeding: a randomized trial. Endoscopy. 2003;35:729–735
  21. See A, Florent C, Lamy P, et al. Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients. Gastroenterol Clin Biol. 1986;10:604–607
  22. Gallet B, Zemour G, Saudemont JP, et al. Echocardiographic demonstration of intracardiac glue after endoscopic obturation of gastroesophageal varices. J Am Soc Echocardiogr. 1995;8:759–761
  23. D'Imperio N, Piemontese A, Baroncini D, et al. Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy. 1996;28:239–243
  24. Shim CS, Cho YD, Kim JO, et al. A case of portal and splenic vein thrombosis after Histoacryl injection therapy in gastric varices. Endoscopy. 1996;28:461
  25. Naga M, Foda A. An unusual complication of Histoacryl injection. Endoscopy. 1997;29:140
  26. Cheng PN, Sheu BS, Chen CY, et al. Splenic infarction after histoacryl injection for bleeding gastric varices. Gastrointest Endosc. 1998;48:426–427
  27. Tsokos M, Bartel A, Schoel R, et al. Fatal pulmonary embolism after endsocopic embolization of downhill esophageal varix. Dtsch Med Wochenschr. 1998;123:691–695
  28. Rösch W. UCTN: pulmonary, cerebral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy. 1998;30:S89–S90
  29. Battaglia G, Morbin T, Patarnello E, et al. Visceral fistula as a complication of endoscopic treatment of esophageal and gastric varices using isobutyl-2-cyanoacrylate: report of 2 cases. Gastrointest Endosc. 2000;52:267–270
  30. Irisawa A, Obara K, Sato Y, et al. Adherance of cyanoacrylate which leaked from gastric varices to the left renal vein during endoscopic injection sclerotherapy: a histopathologic study. Endoscopy. 2000;32:804–806
  31. Hwang SS, Kim HH, Park SH, et al. N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding. J Comput Assist Tomogr. 2001;25:16–22
  32. Türler A, Wolff M, Dorlars D, et al. Embolic and septic complications after sclerotherapy of fundic varices with cyanoacrylate. Gastrointest Endosc. 2001;53:228–230
  33. Dhiman RK, Chawla Y, Taneja S, et al. Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate. J Clin Gastroenterol. 2002;35:222–227
  34. Tan YM, Goh KL, Kamarulzaman A, et al. Multiple systemic embolisms with septicemia after gastric variceal obliteration with cyanoacrylate. Gastrointest Endosc. 2002;55:276–278
  35. Greenwald BD, Caldwell SH, Hespenheide EE, et al. N-butyl-2-cyanoacrylate for bleeding gastric varices: a United States pilot study and cost analysis. Am J Gastroenterol. 2003;98:1982–1988
  36. Sato T, Yamazaki K, Toyota J, et al. Inflammatory tumor in pancreatic tail induced by endoscopic ablation with cyanoacrylate glue for gastric varices. J Gastroenterol. 2004;39:476–478
  37. Wahl P, Lammer F, Conen D, et al. Septic complications after injection of N-butyl-2-cyanoacrylate: report of 2 cases and review. Gastrointest Endosc. 2004;59:911–915
  38. Kok K, Bond RP, Duncan IC, et al. Distal embolization and local vessel wall ulceration after gastric variceal obliteration with N-butyl-2-cyanoacrylate: a case report and review of the literature. Endoscopy. 2004;36:442–446
  39. Yu LK, Hsu CW, Tseng JH, et al. Splenic infarction complicated by splenic artery occlusion after N-butyl-2-cyanoacrylate injection for gastric varices: case report. Gastrointest Endosc. 2005;61:343–345
  40. Seewald S, Sriram PV, Naga M, et al. Cyanoacrylate glue in gastric variceal bleeding. Endoscopy. 2002;34:926–932
  41. Soehendra N, Nam VC, Grimm H, et al. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986;18:25–26
  42. Soehendra N, Grimm H, Nam VC, et al. 10 years' experience with endoscopic sclerotherapy of esophagogastric varices. Chirurgie. 1989;60:594–598
  43. Sarin SK, Jain AK, Jain M, et al. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:1010–1015
  44. Maluf-Filho F, Sakai P, Ishioka S, et al. Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding: a prospective, controlled and randomized study in Child-Pugh class C patients. Endoscopy. 2001;33:421–427
  45. Lee YT, Chan FK, Ng EK, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52:168–174
  46. Miyazaki S, Yoshida T, Harada T, et al. Injection sclerotherapy for gastric varices using N-butyl-2-cyanoacrylate and ethanolamine oleate. Hepatogastroenterology. 1998;45:1155–1158
  47. Kind R, Guglielmi A, Rodella L, et al. Bucrylate treatment of bleeding gastric varices: 12 years experience. Endoscopy. 2000;32:512–519
  48. Mahadeva S, Bellamy MC, Kessel D, et al. Cost effectiveness of N-butyl-2-cyanoacrylate (Histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of acute gastric variceal bleeding. Am J Gastroenterol. 2003;98:2688–2693
  49. Thakeb F, Salama Z, Salama H, et al. The value of combined use of N-butyl-2-cyanoacrylate and ethanolamine oleate in the management of bleeding esophagogastric varices. Endoscopy. 1995;27:358–364
  50. Ogawa K, Ishikawa S, Naritaka Y, et al. Clinical evaluation of endoscopic injection sclerotherapy using N-butyl-2-cyanoacrylate for gastric variceal bleeding. J Gastroenteol Hepatol. 1999;14:245–250
  51. Mumtaz K, Majid S, Shah HA, et al. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding. World J Gastroenterol. 2007;13:1247–1251
  52. Lo GH, Liang HL, Chen WC, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39:679–685
  53. Battaglia G, Bocus P, Morbin T, et al. Endoscopic Doppler US–guided injection therapy for gastric varices: case report. Gastrointest Endosc. 2003;57:608–611
  54. Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M, et al. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc. 2007;66:402–407
  55. Chen WC, Hou MC, Lin HC, et al. Bacteraemia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding. Gastrointest Endosc. 2001;54:214–218
  56. Bernard B, Grange JD, Khac EN, et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:1655–1661
  57. Hirota WK, Petersen K, Baron TH, et al. Guidelines for antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2003;58:475–482

 Presented at Digestive Disease Week, May 2005, Chicago, Illinois, USA (Gastrointest Endosc 2005;61:AB91).

 See CME section; p. 532.

PII: S0016-5107(08)00282-4

doi: 10.1016/j.gie.2008.02.050

Gastrointestinal Endoscopy
Volume 68, Issue 3 , Pages 447-454 , September 2008

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