Clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt: a multicenter study

Abstract

Background The aim of this study was to evaluate the safety and efficacy of clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt.

Methods Records were reviewed of patients with gastric varices and concomitant gastrorenal shunts who underwent clip-assisted endoscopic cyanoacrylate injection at three tertiary centers between April 2016 and October 2018. The assessed outcomes were technical success rate, eradication of gastric varices, cyanoacrylate embolization, and all-cause rebleeding.

Results A total of 61 patients were analyzed. The procedure was successful in all patients (100 %). Gastric varices were eradicated in 30 of 33 patients (90.9 %) according to contrast-enhanced computed tomography re-examination within 1 month after the procedure. No symptoms or signs of cyanoacrylate embolization related to the procedure were observed. Four patients (6.6 %) were lost to follow-up. All-cause rebleeding occurred in 13/57 patients (22.8 %) during a median follow-up period of 225 days (interquartile range 114 – 507 days).

Conclusions Clip-assisted endoscopic cyanoacrylate injection appeared to be a safe procedure that was convenient and efficacious in the treatment of gastric varices with concomitant gastrorenal shunt.

^* Co-first authors.

• References

• 1 Sarin SK, Lahoti D, Saxena SP. et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16: 1343-1349
• 2 Kim T, Shijo H, Kokawa H. et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology 1997; 25: 307-312
• 3 de Franchis R. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752
• 4 Koksal AS, Kayacetin E, Torun S. et al. Splenic infarction after N-butyl-2-cyanoacrylate injection for gastric varices: why does it happen?. Surg Laparosc Endosc Percutan Tech 2013; 23: e191-e193
• 5 Upadhyay AP, Ananthasivan R, Radhakrishnan S. et al. Cortical blindness and acute myocardial infarction following injection of bleeding gastric varices with cyanoacrylate glue. Endoscopy 2005; 37: 1034
• 6 Kok K, Bond RP, Duncan IC. et al. Distal embolization and local vessel wall ulceration after gastric variceal obliteration with N-butyl-2-cyanoacrylate: a case report and review of the literature. Endoscopy 2004; 36: 442-446
• 7 Zeng X, Ma L, Tseng Y. et al. Endoscopic cyanoacrylate injection with or without lauromacrogol for gastric varices: a randomized pilot study. J Gastroenterol Hepatol 2017; 32: 631-638
• 8 Garcia-Tsao G, Abraldes JG, Berzigotti A. et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65: 310-335
• 9 Yol S, Belviranli M, Toprak S. et al. Endoscopic clipping versus band ligation in the management of bleeding esophageal varices. Surg Endosc 2003; 17: 38-42
• 10 Li H, Ye D, Kong D. Endoscopic clipping prior to n-butyl-2-cyanoacrylate injection for gastric varices with a large gastrorenal shunt. Endoscopy 2018; 50: E102-E103
• 11 Caldwell SH, Hespenheide EE, Greenwald BD. et al. Enbucrilate for gastric varices: extended experience in 92 patients. Aliment Pharmacol Ther 2007; 26: 49-59
• 12 Huang YH, Yeh HZ, Chen GH. et al. Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety. Gastrointest Endosc 2000; 52: 160-167
• 13 Mosli MH, Aljudaibi B, Almadi M. et al. The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre. Saudi J Gastroenterol 2013; 19: 152-159
• 14 Kang EJ, Jeong SW, Jang JY. et al. Long-term result of endoscopic Histoacryl (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices. World J Gastroenterol 2011; 17: 1494-1500