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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(01): 037-043
DOI: 10.1055/s-0045-1806741
Research Article

Endoscopic Cyanoacrylate Injection in the Management of Gastric Varices: Long-Term Safety and Efficacy

Anand Kumar Raghavendran
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Shiran Shetty
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Balaji Musunuri
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Siddheesh Rajpurohit 
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Preety Kumari
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Suriya Nedunchezhian
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Athish Shetty
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
C. Ganesh Pai
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Ganesh Bhat 
1   Department of Gastroenterology and Hepatology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
› Author Affiliations Funding None declared.
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Abstract

Introduction

Despite endoscopic ultrasound-based endotherapy and radiologic intervention, endoscopic cyanoacrylate (E-CYA) injection still remain as commonly performed treatment modality for bleeding gastric varices (GVs) in real world. We analyzed the long-term safety and efficacy of E-CYA in bleeding GVs.

Patients and Methods

In this retrospective analysis, patients who underwent E-CYA for GVs over the past 10 years were analyzed. The technical success, hemostasis rate, rebleeding rate, mortality rate, and procedure-related complications were analyzed. The predictive factors for a rebleed in terms of Child–Pugh status, the type, form, and size of GVs were computed.

Results

Of the 113, 96 (84.9%) met the inclusion criteria. The median follow-up was 30 (12–49) months. The mean age was 48.1 ± 6.1 years with most being male (83.3%, n = 80). The majority of them had cirrhosis (85.4%, n = 82). The technical success to achieve primary hemostasis was 98.9%. The median volume of glue to achieve hemostasis for each session was 2 (2–4) mL. At 1 month, 12 patients had a clinically significant rebleed (12.5%) and 6 (6.3%) had a rebleed at 6 months. At 1 and 6 months, 68.75% did not require further glue injection. The disease-related mortality was 10.41%. There was no procedure-related mortality.

Conclusion

E-CYA injection shows excellent efficacy and long-term safety with low rebleeding rates and negligible procedure-related complications.

Keywords

gastric varices - glue injection - safety and efficacy

Ethical Approval and Consent to Participate

Taken from institutional ethical committee.


Consent for Publication

Sought from the patient.


Availability of Supporting Data

Available from G.B. upon reasonable request.


Authors' Contributions

A.K. and S.N.: Preparing the primary draft of the manuscript. P.K., A.S., and B.M.: Data collection. G.P.C., G.B., and S.S.: Review of the manuscript. S.R.: Statistical analysis.




Publication History

Article published online:
17 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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