Laser Disintegration of Cyanoacrylate Clot with Successful Endoscopic Removal of Sclerotherapy Needle from Gastric Varix

Introduction

Intravariceal cyanoacrylate injection is a highly effective and safe procedure for the treatment of bleeding gastric varices. Reports of large series mostly describe the minor complications already recognized with endoscopic injection therapy with sclerosing agents, including dysphagia, chest pain, fever, and local ulcerations. Nevertheless, some cases of severe cyanoacrylate-specific complications due to embolization have been described [1] [2] [3]. Technical difficulties, including the risk of sclerotherapy needle clogging, and cyanoacrylate sticking to the tip and the accessory channel of the endoscope, have been mentioned in other reports [4] [5].

Cementation of the sclerotherapy needle into the glued varix is another serious side effect of cyanoacrylate injection which has been reported by some investigators [4] [6]. The endoscopic removal of an adhered injector is difficult to perform and can result in fatal hemorrhage.

We report a case in which a sclerotherapy needle that remained stuck in gastric varices after bucrylate injection was successfully removed by laser disintegration of the cyanoacrylate clot.

References

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