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Canadian Journal of Gastroenterology
Volume 24, Issue 10, Pages 593-596
http://dx.doi.org/10.1155/2010/276273
Original Article

Endoscopic Management of Gastric Variceal Bleeding with Cyanoacrylate Glue Injection: Safety and Efficacy in a Canadian Population

Jaber Al-Ali,1 Monika Pawlowska,2 Alan Coss,3 Sigrid Svarta,2 Michael Byrne,3 and Robert Enns2

1Department of Medicine, Kuwait University, Kuwait
2Department of Medicine, Division of Gastroenterology, St Paul’s Hospital, Vancouver, Canada
3Department of Medicine, Division of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada

Received 25 March 2010; Accepted 1 June 2010

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Gastric variceal bleeding (GVB) is a major cause of morbidity and mortality among patients with portal hypertension. Endoscopic band ligation and standard sclerotherapy have been used but have significant limitations. Decompression through transjugular intrahepatic portosystemic shunt insertion has been shown to be effective. Gastric variceal injection therapy with a commercially available cyanoacrylate glue is less invasive than transjugular intrahepatic portosystemic shunt insertion and has recently been shown to be effective for acute hemostasis.

OBJECTIVE: To assess the immediate and long-term outcomes of cyanoacrylate glue injection therapy for GVB.

METHODS: A retrospective chart review was conducted to identify patients treated with cyanoacrylate injection for GVB at two tertiary care hospitals over a period of six years. The outcomes assessed included complications, acute hemostasis, rebleeding rate and all-cause mortality.

RESULTS: Thirty-seven patients (60% men) underwent cyanoacrylate glue injections for GVB. The median follow-up period was 14 months and included 29 patients (eight were lost to follow-up). Initial hemostasis was achieved in 35 patients (95%). No significant complications from cyanoacrylate injection were observed. Early rebleeding was rare (8%) and late rebleeding occurred in only 28% of patients. The all-cause mortality rate was 28.6% during the median follow-up period.

CONCLUSION: The data suggest that cyanoacrylate injection therapy is safe and effective for the prevention of short- and long-term bleeding from gastric varices. Furthermore, although these patients had significant comorbid disease, survival in the follow-up time period was greater than 70%.