Premium
Cyanoacrylate therapy for the treatment of gastric varices: a new method
Author(s) -
Singh Virendra,
Singh Ranjan,
Bhalla Ashish,
Sharma Navneet
Publication year - 2016
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12351
Subject(s) - medicine , cyanoacrylate , gastric varices , lipiodol , adverse effect , surgery , randomized controlled trial , embolization , radiology , varices , cirrhosis , chemistry , adhesive , organic chemistry , layer (electronics)
Objective Cyanoacrylate (CYA) injection is recommended for bleeding gastric varices (GV) but with significant adverse effects. Transesophageal endoscopic ultrasound‐guided therapy of large GV with a combined coil and CYA injection has shown promising results. However, it is expensive and requires technical expertise. In this study, we aimed to compare the safety and efficacy of a new method with UCYA [undiluated CYA (UCYA) followed by lipiodol‐diluated CYA (DCYA)] in the management of large bleeding GV. Methods Fifteen consecutive patients with bleeding from large GV (>1 cm) were prospectively treated with DCYA and another 15 patients treated with UCYA retrospectively. All patients in the DCYA group underwent thoracic computed tomography scan to identify glue embolism. Results Baseline characteristics were similar between the two groups. Rates of GV obliteration and rebleeding were 100% vs 93.3% ( P = 0.309) and 6.7% vs 33.3% ( P = 0.06) in the DCYA and UCYA groups, respectively. One patient in the UCYA group had needle fixation which led to fatal bleeding after forceful needle extraction. In DCYA group none had glue embolism. Conclusions Both UCYA and DCYA are effective in treating bleeding from large GV. DCYA has lower rebleeding rates and tends to have fewer adverse events than UCYA injection, although the differences are not statistically significant. Large‐sample‐sized prospective randomized trials are required.