Obliterating gastric varices with glue injection: efficacy, safety and rebleeding risk factors

Aims Endoscopic management of gastric variceal (GV) bleeding has been premised on the injection of biological glue. The aim of this study was to assess the efficacy and safety of biological glue injection (GI) in the treatment of hemorrhagic GV and identify predictive risk factors of bleeding recurrence (BR).

Methods We conducted a retrospective study, over a period of 13 years [2010 – 2022], including patients with bleeding GV treated with biological GI. Demographic data and endoscopic findings were collected as well as follow-up information.

Results Thirty-eight patients were included with a mean age of 58.4 years. Portal hypertension syndrome was mostly caused by cirrhosis (81.6%). Clinical presentation of GV rupture was gastrointestinal bleeding (92.1%) and deglobulisation in the rest of the cases. Bleeding GV were type 2 gastroesophageal varices (57%), type 1 gastroesophageal varices (39.5%), and type 1 isolated GV (15.8%). GI was performed within a median time of 3 days after hospitalization without any incident. Primary hemostasis was obtained in 100% of cases. Endoscopic treatment was complicated in 2 cases by pulmonary embolism secondary to glue migration in one case and severe sepsis in the other. BR due to GV rupture was noted in 9 patients (23.6%). Risk factors associated with a bleeding recurrence were Child-Pugh B or C score (p=0.04), as well as hypertensive gastropathy (p=0.03). In multivariate analysis, only hypertensive gastropathy was significantly associated to recurrence.

Conclusions Factors predisposing to BR after obliteration of GV with GI are poorly studied and defined. Identification of these factors would help select most-eligible patients of stricter monitoring.

Publication History

Article published online:
14 April 2023