Evaluation of Undiluted N-Butyl-2-Cyanoacrylate in the Endoscopic Treatment of Upper Gastrointestinal Tract Varices

Abstract

Background and Study Aims: Endoscopic obliteration of upper gastrointestinal tract varices using N-butyl-2-cyanoacrylate has been proposed by some authors. The aim of the present study was to evaluate prospectively the efficacy and safety of this technique, using the undiluted substance, in obtaining hemostasis of bleeding upper gastrointestinal tract varices, as well as definitive eradication of varices located in the gastric fundus and duodenum.

Patients and Methods: We carried out variceal injections of N-butyl-2-cyanoacrylate in 80 patients (51 males, 29 females, mean age 68 years, range 19 - 80) with upper gastrointestinal tract varices. In 24 patients, the varices were located in the esophagus, in 54 in the gastric fundus, and in the remaining two they were in the duodenum. Forty-eight patients were treated for active variceal bleeding, and the other 32 were treated electively.

Results: Hemostasis was achieved in 43 of the 48 patients (89.6 %) treated for active variceal bleeding. Eradication was obtained in 49 of the 56 patients (87.5 %) with gastric or duodenal varices. Overall complications occurred in 11 patients (10.4 %). In two patients, embolization was found, and in a further two patients it was clinically suspected, but could not be proved. Ten patients (12.5 %) died during the treatment period, six due to uncontrolled bleeding, two due to rebleeding, and two due to liver failure.

Conclusions: Endoscopic injection of N-butyl-2-cyanoacrylate appears to be both safe and effective in the treatment of bleeding gastrointestinal tract varices. The relative value of the undiluted substance versus the diluted one should be further evaluated.