Objective: To evaluate the safety and efficacy of the endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric fundal varices.
Methods: The medical records of cirrhotic and non-cirrhotic patients who underwent at least one episode of endoscopic application of N-butyl-2-cyanoacrylate-lipiodol mixture for gastric varices at our gastroenterology clinic between October 2004 and January 2010 were reviewed. The technique comprised the dilution of 0.5 mL of cyanoacrylate with 0.5 mL of lipiodol and repeating intravariceal injections of 1.0 mL each until hemostasis was achieved.
Results: A total of 66 patients (41 male and 25 female) with gastric varices underwent 86 endoscopic injections of cyanoacrylate for hemostasis. Overall 38 patients (57.6%) had active bleeding during the endoscopic procedure, while the remaining 28 (42.4%) underwent cyanoacrylate under elective conditions. In one patient (1.5%) hemostasis could not be achieved, prompting referral for emergency surgery. The median number of sessions was one (range 1-3). Eleven patients (16.6%) rebled during a median follow-up period of 6.02 months (0.1-62.4 months). There was no bleeding-related death. One patient developed splenic infarction a day after N-butyl-2-cyanoacrylate injection.
Conclusion: Endoscopic injection therapy combining cyanoacrylate and lipiodol is effective for bleeding gastric fundal varices.
© 2010 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.