Advertisement

Endoscopic treatment of gastroesophageal varices in young infants with cyanoacrylate glue: a pilot study

  • Christine Rivet
    Affiliations
    Current affiliations: Department of Pediatrics, Division of Gastroenterology and Nutrition (C.R., C.L., A.L.), Department of Digestive Diseases (C.R-M., J.D., T.P.), Centre Maladie Rare–Maladie de Wilson (C.R-M., J.D., A.L.), Hôpital Edouard Herriot, Lyon, France
    Search for articles by this author
  • Carlos Robles-Medranda
    Affiliations
    Current affiliations: Department of Pediatrics, Division of Gastroenterology and Nutrition (C.R., C.L., A.L.), Department of Digestive Diseases (C.R-M., J.D., T.P.), Centre Maladie Rare–Maladie de Wilson (C.R-M., J.D., A.L.), Hôpital Edouard Herriot, Lyon, France
    Search for articles by this author
  • Jérôme Dumortier
    Correspondence
    Reprint requests: Jérôme Dumortier, MD, PhD, Pavillon H, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.
    Affiliations
    Current affiliations: Department of Pediatrics, Division of Gastroenterology and Nutrition (C.R., C.L., A.L.), Department of Digestive Diseases (C.R-M., J.D., T.P.), Centre Maladie Rare–Maladie de Wilson (C.R-M., J.D., A.L.), Hôpital Edouard Herriot, Lyon, France
    Search for articles by this author
  • Catherine Le Gall
    Affiliations
    Current affiliations: Department of Pediatrics, Division of Gastroenterology and Nutrition (C.R., C.L., A.L.), Department of Digestive Diseases (C.R-M., J.D., T.P.), Centre Maladie Rare–Maladie de Wilson (C.R-M., J.D., A.L.), Hôpital Edouard Herriot, Lyon, France
    Search for articles by this author
  • Thierry Ponchon
    Affiliations
    Current affiliations: Department of Pediatrics, Division of Gastroenterology and Nutrition (C.R., C.L., A.L.), Department of Digestive Diseases (C.R-M., J.D., T.P.), Centre Maladie Rare–Maladie de Wilson (C.R-M., J.D., A.L.), Hôpital Edouard Herriot, Lyon, France
    Search for articles by this author
  • Alain Lachaux
    Affiliations
    Current affiliations: Department of Pediatrics, Division of Gastroenterology and Nutrition (C.R., C.L., A.L.), Department of Digestive Diseases (C.R-M., J.D., T.P.), Centre Maladie Rare–Maladie de Wilson (C.R-M., J.D., A.L.), Hôpital Edouard Herriot, Lyon, France
    Search for articles by this author
Published:January 19, 2009DOI:https://doi.org/10.1016/j.gie.2008.07.025

      Background

      In children, endoscopic sclerotherapy and variceal ligation (EVL) are the most used techniques for the treatment of gastroesophageal variceal bleeding (VB). However, these techniques achieve poor results in cases of gastric variceal bleeding, and EVL is not applicable in young infants.

      Objective

      Our purpose was to evaluate the feasibility, efficacy, and safety of cyanoacrylate glue injection for the treatment of gastroesophageal varices in young infants.

      Design

      Single-center prospective study.

      Patients

      From 2001 to 2005, 8 young infants (≤2 years old, ≤10 kg) with portal hypertension and gastroesophageal varices underwent treatment with N-butyl-2-cyanoacrylate.

      Main Outcome Measurements

      Demographic data and the results were registered and analyzed at 1, 6, and 12 months after treatment.

      Results

      The mean age and weight were 1.3 ± 0.42 years (range 0.8 to 1.9 years) and 8.5 ± 1.6 kg (range 5.5 to 10 kg). Glue injection was successfully performed in all infants. The mean volume injected was 1.15 ± 0.62 mL (range 0.5 to 2 mL). Immediate control of bleeding was achieved in all cases. Ulcer bleeding as a complication was observed in 1 case. Varices relapse with bleeding was observed in 3 of 8 (37.5%) patients after a mean of 12.5 ± 10.6 weeks (range 5 to 20 weeks). Patients with variceal rebleeding were retreated. Varices eradication was achieved in all cases after a mean of 1.4 ± 0.52 sessions (range 1 to 2 sessions).

      Limitations

      Open prospective series with a relatively small number of patients.

      Conclusion

      In young infants, the use of cyanoacrylate glue is safe and effective for the treatment of gastroesophageal VB.

      Abbreviations:

      EVL (endoscopic variceal ligation), EVS (endoscopic variceal sclerotherapy), IGV (type II gastric varices), GOV (type 1 gastric varices), GV (gastric varices), PELD (pediatric end-stage liver disease), VB (variceal bleeding)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zargar S.A.
        • Javid G.
        • Khan B.A.
        • et al.
        Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction.
        Hepatology. 2002; 36: 666-672
        • Huang Y.H.
        • Yeh H.Z.
        • Chen G.H.
        • et al.
        Endoscopic treatment of bleeding GV by N-butyl-2-cyanoacrylate (Histoacryl) injection: long term efficacy and safety.
        Gastrointest Endosc. 2000; 52: 160-167
        • Sarin S.K.
        • Lahoti D.
        • Saxena S.P.
        • 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
        • Hashizume M.
        • Kitano S.
        • Yamaga H.
        • et al.
        Endoscopic classification of gastric varices.
        Gastrointest Endosc. 1990; 36: 276-280
        • Kim T.
        • Shijo H.
        • Kokawa H.
        • et al.
        Risk factors for hemorrhage from gastric fundal varices.
        Hepatology. 1997; 25: 307-312
        • Wiesner R.H.
        • McDiarmid S.Y.
        • Kamath P.S.
        • et al.
        MELD and PELD: application of survival models to liver allocation.
        Liver Transplant. 2001; 7: 567-580
        • Sarin S.K.
        • Kumar A.
        Gastric varices: profile, classification and management.
        Am J Gastroenterol. 1989; 84: 1244-1249
        • Paquet K.J.
        Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices: a prospective controlled randomized trial.
        Endoscopy. 1982; 14: 4-5
        • Seewald S.
        • Sriram P.V.J.
        • Naga M.
        • et al.
        Cyanoacrylate glue in gastric variceal bleeding.
        Endoscopy. 2002; 34: 926-932
        • Park W.G.
        • Yeh R.W.
        • Triadafilopoulos G.
        Injection therapy for variceal bleeding disorders of the GI tract.
        Gastrointest Endosc. 2008; 67: 313-323
        • D'Amico G.
        • Pagliaro L.
        • Bosch J.
        The treatment of portal hypertension: a meta-analytic review.
        Hepatology. 1995; 22: 332-354
        • Schuman B.M.
        • Beckman J.W.
        • Tedesco F.J.
        • et al.
        Complications of endoscopic injection sclerotherapy: a review.
        Am J Gastroenterol. 1987; 82: 823-830
        • Al Traif I.
        • Fachartz F.S.
        • Al Jumah A.
        • et al.
        Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices.
        Gastrointest Endosc. 1999; 50: 1-6
        • Howard E.R.
        • Stringer M.D.
        • Mowat A.P.
        Assessment of injection sclerotherapy in the management of 152 children with esophageal varices.
        Br J Surg. 1988; 75: 404-408
        • McKiernan P.J.
        • Beath S.V.
        • Davison S.M.
        A prospective study of endoscopic esophageal variceal ligation using a multiband ligator.
        J Pediatr Gastroenterol Nutr. 2002; 34: 207-211
        • Zargar S.A.
        • Javid G.
        • Khan B.A.
        • et al.
        Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction.
        Hepatology. 2002; 36: 666-672
        • Lo G.H.
        • Lai K.H.
        • Cheng J.S.
        • et al.
        A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices.
        Hepatology. 1995; 22: 466-471
        • Baroncini D.
        • Milandri G.L.
        • Borioni D.
        • et al.
        A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal varices.
        Endoscopy. 1997; 29: 235-240
        • Laine L.
        • Cook D.
        Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding: a meta-analysis.
        Ann Intern Med. 1995; 123: 280-287
        • Poddar U.
        • Thapa B.R.
        • Singh K.
        Frequency of gastropathy and gastric varices in children with extrahepatic portal venous obstruction treated with sclerotherapy.
        J Gastroenterol Hepatol. 2004; 19: 1253-1256
        • Itha S.
        • Yachha S.K.
        Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction.
        J Pediatr Gastroenterol Nutr. 2006; 42: 196-200
        • Mitsunaga T.
        • Yoshida H.
        • Kouchi K.
        • et al.
        Pediatric gastroesophageal varices: treatment strategy and long-term results.
        J Pediatr Surg. 2006; 41: 1980-1983
        • Bryant M.L.
        • Caldwell S.H.
        • Greenwald B.D.
        Endoscopic treatment of gastric varices: use of band ligation, cyanoacrylate glue and novel therapies.
        Tech Gastrointest Endosc. 2005; 7: 26-31
        • Ryan B.M.
        • Stockbrugger R.W.
        • Ryan J.M.
        A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices.
        Gastroenterology. 2004; 126: 1175-1189
        • Lee M.S.
        • Cho J.Y.
        • Cheon Y.K.
        • et al.
        Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices.
        Gastrointest Endosc. 2002; 56: 83-88
        • Reinoso M.
        • Sharp H.
        • Rank J.
        Endoscopic variceal ligation in pediatric patients with portal hypertension secondary to liver cirrhosis.
        Gastrointest Endosc. 1997; 46: 244-246
        • Price M.R.
        • Sartorelli K.H.
        • Narkewicz M.R.
        • et al.
        Management of esophageal varices in children by endoscopic variceal ligation.
        J Pediatr Surg. 1996; 31: 1056-1059
        • Fox V.L.
        • Carr-Locke D.L.
        • Connors P.J.
        • et al.
        Endoscopic ligation of esophageal varices in children.
        J Pediatr Gastroenterol Nutr. 1995; 20: 202-208
        • Lo G.H.
        • Lai K.H.
        • Cheng J.S.
        • 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
        • Ogawa K.
        • Ishikawa S.
        • Naritaka Y.
        • et al.
        Clinical evaluation of endoscopic injection sclerotherapy using n-butyl-2-cyanoacrylate for gastric variceal bleeding.
        J Gastroenterol Hepatol. 1999; 14: 245-250
        • Lidove O.
        • Gervais A.
        • Malphettes M.
        • et al.
        Infection after cyanoacrylate injection: a fatal complication in a patient with portal hypertension associated with common variable immuno-deficiency.
        Endoscopy. 2007; 39: E180-E181
        • Saracco G.
        • Giordanino C.
        • Roberto N.
        • et al.
        Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension.
        Gastrointest Endosc. 2007; 65: 345-347
        • Evrard S.
        • Dumonceau J.M.
        • Delhaye M.
        • et al.
        Endoscopic histoacryl obliteration vs. propranolol in the prevention of esophagogastric variceal rebleeding: a randomized trial.
        Endoscopy. 2003; 35: 729-735
        • Park W.G.
        • Yeh R.W.
        • Triadafilopoulos G.
        Injection therapies for variceal bleeding disorders of the GI tract.
        Gastrointest Endosc. 2008; 67: 313-323
        • Saracco G.
        • Giordanino C.
        • Roberto N.
        • et al.
        Fatal multiple systemic embolisms after injection of cyanoacrylate in bleeding gastric varices of a patient who was noncirrhotic but with idiopathic portal hypertension.
        Gastrointest Endosc. 2007; 65: 345-347
        • Fuster S.
        • Costaguta A.
        • Tabacco O.
        Sclerotherapy of bleeding gastric varices with cyanoacrylate in children.
        Gastroenterology. 1998; 114 ([abstract]): A1244