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Low Incidence of Complications From Endoscopic Gastric Variceal Obturation With Butyl Cyanoacrylate

https://doi.org/10.1016/j.cgh.2010.05.019Get rights and content

Background & Aims

Endoscopic variceal obturation with tissue adhesive is used to control gastric variceal bleeding. We investigated the prevalence of serious complications from this therapy.

Methods

We performed a retrospective analysis of complications that occurred in 753 patients with gastric variceal hemorrhages who were hospitalized in 2 tertiary referral hospitals. All patients received N-butyl-2-cyanoacrylate as therapy for endoscopic variceal obturation.

Results

Complications occurred in 51 patients. Thirty-three patients experienced rebleeding because of early-onset (within 3 months) extrusion of the N-butyl-2-cyanoacrylate glue cast (4.4%), 10 patients developed sepsis (1.3%), and 5 patients developed distant embolisms (0.7%; 1 pulmonary, 1 brain, and 3 splenic). One patient had major gastric variceal bleeding after endoscopic variceal obturation (0.1%), 1 developed a large gastric ulcer (0.1%), and 1 had mesentery hematoma, hemoperitoneum, and infection in the abdominal cavity (0.1%). The complication-related mortality was 0.53% (3 deaths from sepsis and 1 death from rebleeding after early-onset glue cast extrusion).

Conclusions

The occurrence of complications after endoscopic variceal obturation with N-butyl-2-cyanoacrylate in gastric varices treatment is rare.

Section snippets

Patients

The patient population consisted of 3346 consecutively admitted patients with episodes of variceal bleeding who received endoscopic therapy and were hospitalized in either the General Hospital of Chinese People's Liberation Army (GHCPLA) between January 1996 and April 2006 or Beijing Shijitan Hospital (BSH) between March 2003 and December 2007. This study population was divided into 2 groups, a cohort comprising 2953 cases with esophageal variceal bleeding who received either EVL or EVS and 753

Follow-up

A total of 49 patients (49 of 753, 6.5%) died, and 68 patients were lost during follow-up. The causes of death were 14 cases from liver failure, 14 from uncontrolled upper gastrointestinal bleeding, 11 from liver cancer, 3 from infection and sepsis, 2 from renal failure, and the remaining 5 from other diseases not related to portal hypertension. The survival analysis has been reported elsewhere.12

Rebleeding Due to Early-Onset Extrusion of N-Butyl-2-Cyanoacrylate Cast

Glue cast extrusion usually began 1 month after treatment and rarely occurred after the first year.

Discussion

The use of N-butyl-2-cyanoacrylate for gastric varices treatment was first introduced in 1987.14 Despite its efficacy, EVO with cyanoacrylate can create complications4 including early polymerization leading to needle adhesion to the varices, embolization, bacteremia, esophageal perforation, peritoneal cavity extravasation, and splenic infarction.4, 15, 16, 17

Thromboembolism is a primary complication of EVO with tissue glue. All 5 embolic cases occurred with sandwich injection. The volume of

Acknowledgments

The authors thank Dr James W. Shih from the National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University for his substantial help in the preparation of this paper.

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    Conflicts of interest The authors disclose no conflicts.

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