INJECTION OF CYANOACRYLATE FOR THE TREATMENT OF GASTRIC VARICES BLEEDING

Aims:

The aim of our study is to evaluate the efficacy and safety of gastric varices injection with cyanoacrylate.

Methods:

a prospective study between May 2015 and November 2018, all patients with gastric variceal bleeding was hospitalized and underwent endoscopic treatment. Success was defined as an absence of recurrent bleeding after the cyanoacrylate injection, and safety was evaluated by looking for side effects.

Results:

Thirty three Cyanoacrylate injections were done for 23 patients (13 women and 10 men, the sex ratio was 0.76), the mean age was 43 (ranging from 15 to 77 years old).

All patients had portal hypertension, 17 due to intra-hepatique cause (73.9%), 5 patients had extra-hepatic portal hypertension, and unidentified cause for one patient.

All patients was admitted to the emergency unit for upper gastrointestinal bleeding (hematemesis and melena in 73%), 25% was hemodynamically unstable. The hemoglobin mean rate was 7.2 g/dl (3.8 – 9.8). All patients received early vaso-actif treatment.

The esophagogastroduodenoscopy (EGD) was done in less than 24 hours after the hemorrhage. We found GOV 2 in 82%, GOV 2 and IGV1 in 12.55%.

Commercially flexible sclerotherapy injectors with a 6 mm/21-guage needle were used for gastric variceal injection. N2BC was mixed with Lipiodol at the same proportion (1cc-1cc) with the average of 2 injections spot in every session.

All patients achieved immediate hemostasis so the treatment was successful in 100%, without any complications (epigastric discomfort, fever, embolism, thrombosis) and no endoscope was damaged.

The re-bleeding was noticed in 6 patients, from new gastric varices.

Tow patients died from uncontrolled bleeding away from the N2BC injection.

Conclusions:

The study confirm the efficacy of and safety of cyanoacrylate injection for the treatment and second prophylaxis of gastric varices bleeding.

To confirm it efficacy in the primary prophylaxis, other studies are needed.