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Acrylate glue injection for acutely bleeding oesophageal varices: A prospective cohort study.
Dig Liver Dis. 2009 Oct; 41(10):729-34.DL

Abstract

BACKGROUND

Acrylate glue injection is seldom performed in patients with bleeding oesophageal varices.

AIM

To assess efficacy and safety of acrylate glue injection in patients with bleeding oesophageal varices, as well as the impact of this technique on subsequent variceal ligation.

METHODS

Prospective study on 133 consecutive cirrhotic patients treated by intravariceal injection of undiluted N-butyl-2-cyanoacrylate into the bleeding varix. Outcome measures were initial haemostasis, recurrent bleeding, complications and mortality at 6 weeks.

RESULTS

52 patients were actively bleeding at endoscopy and 81 showed stigmata of recent haemorrhage. Initial haemostasis was achieved in 49/52 active bleeders (94.2% [95% CI 85.1-98.5]). Overall, early recurrent bleeding occurred in 7 patients (5.2% [95% CI 2.3-10.1]). No major procedure-related complication was recorded. At 6 weeks, death occurred in 11 patients, with an overall bleeding-related mortality of 8.2% [95% CI 5.8-15.3]. Mortality was higher in active (15.4% [95% CI 6.9-28.1]) than non-active bleeders (3.7% [95% CI 0.8-10.4], OR 4.7 [95% CI 1.05-28.7], p=0.02). Of those surviving the first bleeding episode, 112 patients subsequently underwent ligation. No technical difficulties were encountered in performing the banding procedure which was successfully completed in all cases.

CONCLUSIONS

Emergency injection of acrylate glue is safe and effective for the treatment of acute bleeding oesophageal varices and does not hamper subsequent variceal ligation.

Authors+Show Affiliations

Division of Gastroenterology, Hospital Maresca, Torre del Greco, Italy. cipollet@tin.itNo 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 availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

19362522

Citation

Cipolletta, L, et al. "Acrylate Glue Injection for Acutely Bleeding Oesophageal Varices: a Prospective Cohort Study." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 41, no. 10, 2009, pp. 729-34.
Cipolletta L, Zambelli A, Bianco MA, et al. Acrylate glue injection for acutely bleeding oesophageal varices: A prospective cohort study. Dig Liver Dis. 2009;41(10):729-34.
Cipolletta, L., Zambelli, A., Bianco, M. A., De Grazia, F., Meucci, C., Lupinacci, G., Salerno, R., Piscopo, R., Marmo, R., Orsini, L., & Rotondano, G. (2009). Acrylate glue injection for acutely bleeding oesophageal varices: A prospective cohort study. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 41(10), 729-34. https://doi.org/10.1016/j.dld.2009.02.006
Cipolletta L, et al. Acrylate Glue Injection for Acutely Bleeding Oesophageal Varices: a Prospective Cohort Study. Dig Liver Dis. 2009;41(10):729-34. PubMed PMID: 19362522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acrylate glue injection for acutely bleeding oesophageal varices: A prospective cohort study. AU - Cipolletta,L, AU - Zambelli,A, AU - Bianco,M A, AU - De Grazia,F, AU - Meucci,C, AU - Lupinacci,G, AU - Salerno,R, AU - Piscopo,R, AU - Marmo,R, AU - Orsini,L, AU - Rotondano,G, Y1 - 2009/04/11/ PY - 2008/11/14/received PY - 2008/12/14/revised PY - 2009/02/10/accepted PY - 2009/4/14/entrez PY - 2009/4/14/pubmed PY - 2009/12/16/medline SP - 729 EP - 34 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 41 IS - 10 N2 - BACKGROUND: Acrylate glue injection is seldom performed in patients with bleeding oesophageal varices. AIM: To assess efficacy and safety of acrylate glue injection in patients with bleeding oesophageal varices, as well as the impact of this technique on subsequent variceal ligation. METHODS: Prospective study on 133 consecutive cirrhotic patients treated by intravariceal injection of undiluted N-butyl-2-cyanoacrylate into the bleeding varix. Outcome measures were initial haemostasis, recurrent bleeding, complications and mortality at 6 weeks. RESULTS: 52 patients were actively bleeding at endoscopy and 81 showed stigmata of recent haemorrhage. Initial haemostasis was achieved in 49/52 active bleeders (94.2% [95% CI 85.1-98.5]). Overall, early recurrent bleeding occurred in 7 patients (5.2% [95% CI 2.3-10.1]). No major procedure-related complication was recorded. At 6 weeks, death occurred in 11 patients, with an overall bleeding-related mortality of 8.2% [95% CI 5.8-15.3]. Mortality was higher in active (15.4% [95% CI 6.9-28.1]) than non-active bleeders (3.7% [95% CI 0.8-10.4], OR 4.7 [95% CI 1.05-28.7], p=0.02). Of those surviving the first bleeding episode, 112 patients subsequently underwent ligation. No technical difficulties were encountered in performing the banding procedure which was successfully completed in all cases. CONCLUSIONS: Emergency injection of acrylate glue is safe and effective for the treatment of acute bleeding oesophageal varices and does not hamper subsequent variceal ligation. SN - 1878-3562 UR - https://www.unboundmedicine.com/medline/citation/19362522/Acrylate_glue_injection_for_acutely_bleeding_oesophageal_varices:_A_prospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(09)00050-4 DB - PRIME DP - Unbound Medicine ER -