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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).
Gastrointest Endosc. 2008 Sep; 68(3):447-54.GE

Abstract

BACKGROUND

N-butyl-2-cyanoacrylate has been successfully used for the treatment of bleeding from gastric fundal varices (FV). However, significant rebleeding rates and serious complications including embolism have been reported.

OBJECTIVE

Our purpose was to analyze the safety and efficacy of N-butyl-2-cyanoacrylate for FV bleeding by using a standardized injection technique and regimen.

DESIGN

Retrospective.

SETTING

Two tertiary referral centers.

PATIENTS

A total of 131 patients (91 men/40 women) with FV underwent obliteration with N-butyl-2-cyanoacrylate by a standardized technique and regimen.

INTERVENTIONS

(1) Dilution of 0.5 mL of N-butyl-2-cyanoacrylate with 0.8 mL of Lipiodol, (2) limiting the volume of mixture to 1.0 mL per injection to minimize the risk of embolism, (3) repeating intravariceal injections of 1.0 mL each until hemostasis was achieved, (4) obliteration of all tributaries of the FV, (5) repeat endoscopy 4 days after the initial treatment to confirm complete obliteration of all visible varices and repeat N-butyl-2-cyanoacrylate injection if necessary to accomplish complete obliteration.

MAIN OUTCOME MEASUREMENTS

Immediate hemostasis rate, early rebleeding rate, bleeding-related mortality rate, procedure-related complications, long-term cumulative rebleeding-free rate, and cumulative survival rate.

RESULTS

Initial hemostasis and variceal obliteration were achieved in all patients. The mean number of sessions was 1 (range 1-3). The mean total volume of glue mixture used was 4.0 mL (range 1-13 mL). There was no occurrence of early FV rebleeding, procedure-related complications, or bleeding-related death. The cumulative rebleeding-free rate at 1, 3, and 5 years was 94.5%, 89.3%, and 82.9%, respectively.

CONCLUSION

Obliteration of bleeding FV with N-butyl-2-cyanoacrylate is safe and effective with use of a standardized injection technique and regimen.

Authors+Show Affiliations

Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18760173

Citation

Seewald, Stefan, et al. "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)." Gastrointestinal Endoscopy, vol. 68, no. 3, 2008, pp. 447-54.
Seewald S, Ang TL, Imazu H, et al. 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). Gastrointest Endosc. 2008;68(3):447-54.
Seewald, S., Ang, T. L., Imazu, H., Naga, M., Omar, S., Groth, S., Seitz, U., Zhong, Y., Thonke, F., & Soehendra, N. (2008). 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). Gastrointestinal Endoscopy, 68(3), 447-54. https://doi.org/10.1016/j.gie.2008.02.050
Seewald S, et al. 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). Gastrointest Endosc. 2008;68(3):447-54. PubMed PMID: 18760173.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Seewald,Stefan, AU - Ang,Tiing Leong, AU - Imazu,Hiroo, AU - Naga,Mazen, AU - Omar,Salem, AU - Groth,Stefan, AU - Seitz,Uwe, AU - Zhong,Yan, AU - Thonke,Frank, AU - Soehendra,Nib, PY - 2006/09/07/received PY - 2008/02/11/accepted PY - 2008/9/2/pubmed PY - 2009/1/7/medline PY - 2008/9/2/entrez SP - 447 EP - 54 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 68 IS - 3 N2 - BACKGROUND: N-butyl-2-cyanoacrylate has been successfully used for the treatment of bleeding from gastric fundal varices (FV). However, significant rebleeding rates and serious complications including embolism have been reported. OBJECTIVE: Our purpose was to analyze the safety and efficacy of N-butyl-2-cyanoacrylate for FV bleeding by using a standardized injection technique and regimen. DESIGN: Retrospective. SETTING: Two tertiary referral centers. PATIENTS: A total of 131 patients (91 men/40 women) with FV underwent obliteration with N-butyl-2-cyanoacrylate by a standardized technique and regimen. INTERVENTIONS: (1) Dilution of 0.5 mL of N-butyl-2-cyanoacrylate with 0.8 mL of Lipiodol, (2) limiting the volume of mixture to 1.0 mL per injection to minimize the risk of embolism, (3) repeating intravariceal injections of 1.0 mL each until hemostasis was achieved, (4) obliteration of all tributaries of the FV, (5) repeat endoscopy 4 days after the initial treatment to confirm complete obliteration of all visible varices and repeat N-butyl-2-cyanoacrylate injection if necessary to accomplish complete obliteration. MAIN OUTCOME MEASUREMENTS: Immediate hemostasis rate, early rebleeding rate, bleeding-related mortality rate, procedure-related complications, long-term cumulative rebleeding-free rate, and cumulative survival rate. RESULTS: Initial hemostasis and variceal obliteration were achieved in all patients. The mean number of sessions was 1 (range 1-3). The mean total volume of glue mixture used was 4.0 mL (range 1-13 mL). There was no occurrence of early FV rebleeding, procedure-related complications, or bleeding-related death. The cumulative rebleeding-free rate at 1, 3, and 5 years was 94.5%, 89.3%, and 82.9%, respectively. CONCLUSION: Obliteration of bleeding FV with N-butyl-2-cyanoacrylate is safe and effective with use of a standardized injection technique and regimen. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/18760173/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__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(08)00282-4 DB - PRIME DP - Unbound Medicine ER -