Glueing of Fundal Varices

Gastric variceal bleeding is an uncommon, serious complication of portal hypertension. The significant morbidity and mortality resulting from bleeding from gastric varices presents a challenge for gastroenterologists. The management of this complication has not been standardized. Although transjugular intrahepatic portosystemic shunt (TIPS) is used in many centres to treat gastric varices, endoscopic treatment with the tissue glue cyanoacrylate (N-butyl-2-cyanoacrylate) has been used successfully in many countries for 20 years and is considered, by many clinicians, to be the optimal initial treatment for bleeding gastric varices (1). Despite the widespread use of cyanoacrylate, there are still controversies in the literature regarding its use. The present article deals with the indications, technique, preparation, catheter use, long-term results and cost-effectiveness of the procedure. Close attention to these recommendations can result in successful and safe usage of the tissue glue. The endoscopy unit planning to perform gastric variceal glueing should have a detailed nursing protocol established before performing this procedure.