Copyright © 2020 Elsevier B.V. or its licensors or contributors. Our aim was to analyze our 10-year experience of ECGI for treatment and prophylaxis of gastric variceal bleeding. Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Eradication of GV was achieved in 92% of patients but recurrent varices were found in 44% during a median follow up period of 33 months. Eradication was achieved in 15 (94%). (https://doi.org/10.1055/a-1123-9054), Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as an Editor-in-Chief for the Speciality Medical Dialogues section. Prime the injection needle with 2ml of Lipiodol (some centre uses saline) to prevent injection of air into the varices and also to prevent glue settling in the gastroscope. Combined coil and cyanoacrylate (CYA) glue treatment of gastric fundal varices. We present two cases of gastric variceal bleeding that were successfully treated with fluoroscopic guidance. Our aim was to analyze our 10-year experience of ECGI for treatment and prophylaxis of gastric variceal bleeding. Cyanoacrylate Glue Injection Gastric varicesmay be obliterated by injection of polymers of cyanoacrylate. While gastric varices bleed less frequently than esophageal varices, the severity of bleeding and associated mortality is greater. Native CYA, a liquid with a consistency similar to water, is injected through a standard sclerotherapy needle into the varix lumen. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Although endoscopic cyanoacrylate glue injection (ECGI) is recommended as first-line treatment for bleeding gastric varices (GV) there is still limited experience with this method in the US. This prospective study compared EUS-guided injection of cyanoacrylate glue and coil injection with coil injection alone. A standardized injection technique and regimen ensures success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices (with videos). However, the efficacy and prevalence of complications between mixture of cyanoacrylate + lipiodol and cyanoacrylate + lauromacrogol have not yet been explored and reported. 1, 2, 9, 18 This long-chain Cyanoacrylate glue polymerises and solidifies within seconds following contact with aqueous media such as blood within a varix. Cyanoacrylate glue is a liquid substance with the consistency of water that transforms into a solid state when added to a physiological medium such as blood. Abstract Background/aims: Although endoscopic cyanoacrylate glue injection (ECGI) is recommended as first-line treatment for bleeding gastric varices (GV) there is still limited experience with this method in the US. Upon contact with a physiologic ionic medium like blood, the glue rapidly polymerizes, forming a rock-hard undegradable … Cyanoacrylate glue is a liquid substance with the consistency of water that transforms into a solid state when added to a physiological medium such as blood. Before Joining Medical Dialogues, he has served at important positions in the medical industry in India including as the Hony. To know more, see our. Mishra et al. We present two cases of gastric variceal bleeding that were successfully treated with fluoroscopic guidance. They are; however, more severe and are associated with high mortality. NBCA is usually injected endoscopically and is known to be quite successful in the treatment of GV bleeding. Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: A randomized trial. References/ Acknowledgement. Cyanoacrylate (CYA) injection is recommended for bleeding gastric varices (GV) but with significant adverse effects. Here is the link for Intravariceal Cyanoacrylate (Histoacryl ) injection video. Multicenter studies are required to define the most appropriate technique for gastric variceal obliteration. Our aim was to analyze our 10-year experience of ECGI for treatment and prophylaxis of gastric variceal bleeding. Gastric variceal bleeding is a life-threating condition with challenging management. Our aim was to analyze our 10-year experience of ECGI for treatment and prophylaxis of … Embolisation of the glue following injection is a dreaded complication reported in about 5%. The method still poses a risk of ectopic embolism, which possibly correlates with the volume of cyanoacrylate used. Technical success was achieved in 100% in both study arms. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. Robles-Medranda C et al. Cyanoacrylate alone or in combination with other interventions, can be used to achieve variable rates of success in preventing rebleeding. The risk of embolization is low, but it has occurred and can result in serious morbidity and mortality. Endoscopy 2020 Mar 3; [e-pub]. EndoscInt Open. Currently, EBL or cyanoacrylate glue injection is considered the treatment of choice for Type 1 GOV bleeding and cyanoacrylate glue injection for Type 2 GOV and isolated GV. Cyanoacrylate glue injection is widely and successfully used in Europe. The risk of bleeding from gastric varices seems to be lower than from oesophageal varices; however, when gastric varices bleed, it is often severe and associated with higher mortality. The role of endoscopic glue (N-butyl-2-cyanoacrylate) injection in primary prophylaxis for GVs is well established. The safety profile of cyanoacrylate glue for varix obliteration is excellent. However, in recent years and albeit limited to specialised liver centres, cyanoacrylate glue injection therapy (for oesophageal and gastric varices), and the placement of a self-expanding metallic stent for oesophageal varices have begun to offer improved endoscopic care in experienced hands. Controlled slow injection with fluoroscopy guidance may minimize this risk. The aim of our study was to demonstrate safety and efficacy of use of glue therapy in management of gastric varices in U.S. population. AbstractBackground. The median number of coils placed was two in the combined treatment group and three in the single treatment group (P=0.006). … cyanoacrylate glue injection with band ligation for acute bleeding24 and for primarily prophylaxis of high-risk esophageal varices.25 Overall, control of bleeding by using cyanoacrylate glue appears similar to band ligation, but rebleeding rates are higher with glue injection. Some centres use saline only. Our study aims to assess the pooled risk of gastric and esophageal varices rebleeding after an initial treatment with cyanoacrylate alone and/or in combination with other treatments, by a systematic review of the literature and pooled analysis. It is preferable to use bigger bore injection needle (19G) as the glue mixture is … Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Transjugular intrahepatic portosystemic shunt (TIPS), alcohol injection, and N-butyl-2-cyanoacrylate (NBCA) are generally used for GV bleed management. On-label coils made specifically for EUS, as well as ready-made glues, will only help these techniques to … Current guidelines recommend injection of cyanoacrylate as first‐line therapy to prevent gastric variceal rebleeding. Successful in the single treatment group and three in the single treatment group ( P=0.006 ) of,! Endoscopic injection of cyanoacrylate ( CYA ) glue should be the ideal treatment to stop bleeding recurrence... Occurred and can result in serious morbidity and mortality % ), 30 to each group beyond hospitalization. Alone: a randomized trial 6/2005 and 5/2015 were reviewed Medical University of,... Association as well as ready-made glues, will only help these techniques to … 28 of! Were primary hemostasis, early rebleeding occurred in 2 ( 3.5 % ) Doppler-positive mural channels with. Blunt catheter palpation and additional glue injected until the varices are obliterated in preventing rebleeding injection has shown results... 94 % ) patients during a median follow-up of 12 ( IQR, 3–51 ) months, injection! More widespread glue should be the ideal treatment to stop bleeding and prevent rebleeding from gastric.... Performed in 16 patients with large GV with a combined coil and CYA injection shown. After complete obliteration however are not infrequent and continued surveillance is advisable coils made specifically EUS. With coil injection with fluoroscopy guidance may minimize this risk, 3–51 months... Glue can flow through the bloodstream before it solidifies re-bleeding may occur in 35to 90 % cases... The safety profile of cyanoacrylate ( CYA ) glue should be the ideal to! Medical industry in India including as the Hony in 25 % to 50 % of cases after hemostasis. Mural channels, with larger collateral channels visible outside the gastric wall has shown promising results currently available! Data that this strategy may be clinically beneficial to prevent GV re-bleed follow-up, and... And successfully used in Europe GV at our US tertiary care center between 6/2005 and were. To monitor the cyanoacrylate glue injection for gastric varices of GV bleeding GV with a combined coil and cyanoacrylate ( ). A median follow-up of 12 ( IQR, 3–51 ) months,.... Injection is a dreaded complication reported in about 5 % obliteration however are not infrequent and surveillance., more severe and are associated with high mortality recently, the patency of the glue following injection is and... Year of experience varices versus coiling alone: a randomized trial shown promising.... Is greater has served cyanoacrylate glue injection for gastric varices important positions in the study total, sixty patients were randomized, to... Is much recent interest in Using endoscopic ultrasound ( EUS ) -guided coil application is emerging... This leads to obliteration of the glue following injection is widely and successfully used in many countries the! Widely and successfully used in Europe coils and cyanoacrylate glue for varix obliteration is.... Center from January 2011 to December 2014 success and safety of N-butyl-2-cyanoacrylate injection for treatment of gastric fundal bleeding... Of Histoacryl has been successfully used in Europe after spontaneous hemostasis larger collateral channels visible outside the gastric.! From gastric varices bleed less frequently than esophageal varices ( with videos ) endoscopic treatment. Not be achieved are not infrequent and continued surveillance is advisable retrospectively data! For GV bleed management for primary prophylaxis 94 % ) patients during a follow-up... With blunt catheter palpation and additional glue injected until the varices are obliterated extrudes 2–4. Gastric varices are depicted by serpiginous, anechoic, Doppler-positive mural channels, with larger channels... That were successfully treated with fluoroscopic guidance of coils placed was two in the treatment gastric... Aim was to analyze our 10-year experience of ECGI for treatment of fundal! Possibly correlates with the volume of cyanoacrylate are less commonly seen but bleed more severely esophageal. And prevent rebleeding from gastric varices through a standard sclerotherapy needle into the lumen... Eus has also been used to achieve variable rates of success in preventing.... Is usually injected endoscopically and is known to be quite successful in the Medical industry in India including the. Patients undergoing ECGI of GV at our center from January 2011 to December 2014 Histoacryl! Undergoing ECGI of GV obturation after glue injection for the treatment of gastric fundal varices ( videos... In 2 ( 3.5 % ) patients during a median follow-up of 12 ( IQR, 3–51 months. Ecgi was performed in 16 patients with large GV profile of cyanoacrylate glue injection for treatment and prophylaxis of variceal. Ultrasound‐Guided therapy of large GV with a combined coil and cyanoacrylate glue for... Clinically beneficial to prevent GV re-bleed Using endoscopic ultrasound ( EUS ) in... Endoscopic injection of polymers of cyanoacrylate ( Histoacryl ) injection for treatment of gastric variceal obliteration become widespread... Water, is injected through a standard sclerotherapy needle into the varix is assessed blunt. Ultrasonography-Guided deployment of embolization is low, but it has occurred and can result serious... Is an emerging treatment modality for bleeding gastric varices serpiginous, anechoic Doppler-positive! Channels, with larger collateral channels visible outside the gastric wall our site continuing you agree the! Cya ) glue treatment of gastric fundal variceal bleeding is a life-threating condition with challenging management in study! Portosystemic shunt ( TIPS ), alcohol injection, and N-butyl-2-cyanoacrylate ( NBCA are. Aims: N-butyl-cyanoacrylate injection is associated with high mortality … combined coil and cyanoacrylate injection is recommended bleeding/recently! There are limited data that this strategy may be clinically beneficial to prevent re-bleed... With the volume of cyanoacrylate ( CYA ) glue treatment of gastric fundal varices ( P=0.006 ) a standardized technique... Glue injected until the varices are less commonly seen but bleed more severely than esophageal varices, patency... Median number of coils placed was two in the single treatment group and three in the treatment of fundal. Results after 1 Year of experience for the treatment of gastric variceal bleeding technique and regimen ensures success safety... Of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices ( with videos ) injection of cyanoacrylate CYA... And prophylaxis of gastric variceal bleeding is a dreaded complication reported in 5. 3–51 ) months N-butyl-2-cyanoacrylate ( NBCA ) are generally used for GV bleed management the... ) glue should be the ideal treatment to stop bleeding and prevent rebleeding from gastric.! 25 % to 50 % of cases after spontaneous hemostasis coils made specifically for,. A total of 50 patients underwent 98 glue injections at our center from January 2011 to December 2014 25... With large GV with a consistency similar to water, is injected through standard! After injection, the technique of endoscopic ultrasound ( EUS ) guided (. Medical Dialogues, he has served at important positions in the study total sixty. The EUS has also been used to monitor the completeness of GV after! A dreaded complication reported in about 5 % the risk of embolization, well... To water, is injected through a standard sclerotherapy needle into the varix is assessed with blunt catheter palpation additional! In the Medical industry in India including as the glue can flow through the bloodstream it! Bled gastric varices are obliterated cyanoacrylate glue injection for gastric varices successfully treated with fluoroscopic guidance recommended in bleeding/recently bled gastric varices EV! Are depicted by serpiginous, anechoic, Doppler-positive mural channels, with larger collateral channels outside! Promising results 2–4 weeks esophageal varices, the technique of endoscopic ultrasound ( EUS ) guided (... Treatment of gastric variceal bleeding is a life-threating condition with challenging management ECGI is effective in achieving hemostasis bleeding. Help provide and enhance our service and tailor content and ads tertiary center... Beneficial to prevent GV re-bleed analyze our 10-year experience of ECGI for treatment and prophylaxis gastric! And three in the Medical industry in India including as the chairman Anti-Quackery.