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263 COMPLICATIONS OF GLUING GASTRIC VARICES P Belletrutti, J Love, J Romagnuolo, R Hilsden, B Kaplan, F Chen, PL Beck Direct injection of N-butyl-2-cyanoacrylate (Histoacryl, B.Braun, Melsungen, Germany) into a gastric varix under endoscopic guidance can effect immediate hemostasis, prevent rebleeding and obliterate gastric varices altogether. Although the efficacy of this technique appears well-established, the main controversy surrounds the occurrence of complications of this procedure.
Department of Internal Medicine, University of Calgary, Calgary, Alberta
This descriptive epidemiological study involves a retrospective chart review of patients undergoing glue injection of gastric varices in the Calgary Health Region over the last six years. Thirty-four patients (19 male, 15 female) underwent a total of 47 separate gluing procedures by 12 different endoscopists. The rate of immediate hemostasis was 93.8% (95%CI 71.3-98.5%), the early rebleeding rate was 10.5% (4.3-24.2%), and the variceal obliteration rate was 84.0% (65.1-93.4%).
In 5 instances, transient fever (>38oC) with no other explanation occurred within 24 hours of the procedure. In 3 of these cases, blood cultures were drawn but did not grow any bacteria. Complications occurred after 5 (10.6%; 4.7-22.6%) procedures, of which 1 was life-threatening. Ulceration at the site of glue injection causing new bleeding occurred three times; all three patients required only supportive care. One patient presented with acute abdominal pain 48 hours post-procedure and a CT scan of the abdomen revealed acute superior mesenteric vein thrombosis. One patient had a non-bleeding varix that bled uncontrollably after glue injection requiring insertion of a Linton tube. No symptomatic glue emboli were observed. Comparison is made to other emerging modalities in the treatment of gastric varices with respect to efficacy and observed complications.
In a large, high volume North American centre, glue injection with cyanoacrylate is safe and effective in the treatment of bleeding and recently bleeding gastric varices. Serious complications can occur, but at an acceptably infrequent rate. This technique is more established and has an equally low complication rate when compared to other emerging modalities in the treatment of gastric varices.