A 69-year-old woman had a history of liver cirrhosis related to chronic hepatitis
C. She underwent endoscopic ligation for esophageal variceal bleeding in February
1996, and injection of endoscopic tissue glue (a mixture of 0.5 ml N -butyl-2-cyanoacrylate with 0.5 ml Lipiodol) for gastric variceal bleeding in November
1998. Gastric variceal hemorrhage recurred in December 1999. An emergency endoscopic
tissue glue injection was performed, and the bleeding stopped immediately. Another
two injections were given to eradicate the residual gastric varices. However, the
mixture of the last injection extruded immediately. Because the bleeding stopped,
the endoscope was removed.
The patient complained of dysphagia soon after the tissue glue injection, and administration
of acetaminophen or prokinetic agents did not relieve this. A follow-up endoscopy
revealed an extrusion of tissue glue that had formed a foreign body trapped in and
occluding the lower esophagus (Figure [1
Figure 1 The endoscopic image shows a firm foreign body (tissue glue) trapped in the lower
esophagus
Variceal injection of tissue glue has been more effective than conventional sclerosants
in the treatment of acute gastric variceal bleeding [1 2 3 4 1
If dysphagia occurs after tissue glue injection for gastric variceal bleeding, esophageal
impaction of the tissue glue should be considered. If this happens, the foreign body
can be removed using an endoscopic Dormia basket.
