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[N-butyl-2-cyanoacrylate for the treatment of gastric varices].
Acta Gastroenterol Latinoam. 2012 Mar; 42(1):27-32.AG

Abstract

OBJECTIVE

To evaluate the success of the treatment with cyanoacrylate in primary hemostasis, rebleeding, and gastric varices eradication.

MATERIAL AND METHODS

In this retrospective study 65 patients with gastric varices treated with N-butyl-2-cyanoacrylate (Histoacryl) were included from January 1999 to January 2008. We used a solution of 0,5 mL of cyanoacrylate and 0.9 mL of lipiodol, utilizing an average of 3.46 mL of this mixture per session (range 1 to 6 mL). Sclerosing needles of 21 gauge were used. Patients were sedated. Data were analyzed using a chi-squared test.

RESULTS

Sixty-five patients were included, 42 men and 23 women with an average age of 53.8 years (range 18 to 76 years). The etiology of the portal hypertension (PH) was cirrhosis in 52 patients (80%), prehepatic PH in 7 (10.8%), and segmentary PH in 3 (4.6%), and non-classified in 3 (4.6%). Cirrhotic patients were classified as Child A in 21 cases, Child B in 25 and Child C in 6. According to the Sarin classification, 7 patients had gastric-oesophageal varices (GOV) type 1, 32 GOV2, 8 GOV1 and 2, and 8 isolated gastric varices (IGV) type 1. Fifty-six patients (86%) presented active bleeding or stigmata of recent bleeding at time of initial endoscopy. Primary hemostasis was achieved in 50 of them (89%) and the remaining 6 required a second session. Eleven patients presented rebleeding within the following 6 weeks and were again treated with cyanoacrylate. Hemostasis was achieved in 8 of them, 2 were referred for surgical management, and 1 received endovascular treatment. Follow-up was able in 53 patients for an average period of 11 months (range 1 to 81 months). During this period, 7 patients presented an episode ofrebleeding and were treated with cyanoacrylate, achieving hemostasis. Eradication of varices was documented on 21 patients (39.6%). The global rate of rebleeding was 37%. One patient developed splenic vein thrombosis as a major complication of treatment.

CONCLUSION

Definitive hemostasis was achieved in 94.6% of patients, with primary hemostasis in 89%. The global rate of rebleeding was 37% and the rate of major complications associated with treatment 0.6%. Eradication of gastric varices was achieved in 35.8% of cases. As these data show, it can be concluded that butyl-cyanoacrylate constitutes an effective method for the treatment of gastric variceal bleeding.

Authors+Show Affiliations

Servicio de Gastroenterología, Hospital San Martín, La Plata, Provincia de Buenos Aires, Argentina. ivanmosca2002@yahoo.com.arNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

spa

PubMed ID

22616494

Citation

Mosca, Iván, et al. "[N-butyl-2-cyanoacrylate for the Treatment of Gastric Varices]." Acta Gastroenterologica Latinoamericana, vol. 42, no. 1, 2012, pp. 27-32.
Mosca I, Ligorría R, Tufare F, et al. [N-butyl-2-cyanoacrylate for the treatment of gastric varices]. Acta Gastroenterol Latinoam. 2012;42(1):27-32.
Mosca, I., Ligorría, R., Tufare, F., Villaverde, A., Baldoni, F., Martínez, H., & Chopita, N. (2012). [N-butyl-2-cyanoacrylate for the treatment of gastric varices]. Acta Gastroenterologica Latinoamericana, 42(1), 27-32.
Mosca I, et al. [N-butyl-2-cyanoacrylate for the Treatment of Gastric Varices]. Acta Gastroenterol Latinoam. 2012;42(1):27-32. PubMed PMID: 22616494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [N-butyl-2-cyanoacrylate for the treatment of gastric varices]. AU - Mosca,Iván, AU - Ligorría,Regina, AU - Tufare,Francisco, AU - Villaverde,Augusto, AU - Baldoni,Fernando, AU - Martínez,Horacio, AU - Chopita,Néstor, PY - 2012/5/24/entrez PY - 2012/5/24/pubmed PY - 2012/12/18/medline SP - 27 EP - 32 JF - Acta gastroenterologica Latinoamericana JO - Acta Gastroenterol Latinoam VL - 42 IS - 1 N2 - OBJECTIVE: To evaluate the success of the treatment with cyanoacrylate in primary hemostasis, rebleeding, and gastric varices eradication. MATERIAL AND METHODS: In this retrospective study 65 patients with gastric varices treated with N-butyl-2-cyanoacrylate (Histoacryl) were included from January 1999 to January 2008. We used a solution of 0,5 mL of cyanoacrylate and 0.9 mL of lipiodol, utilizing an average of 3.46 mL of this mixture per session (range 1 to 6 mL). Sclerosing needles of 21 gauge were used. Patients were sedated. Data were analyzed using a chi-squared test. RESULTS: Sixty-five patients were included, 42 men and 23 women with an average age of 53.8 years (range 18 to 76 years). The etiology of the portal hypertension (PH) was cirrhosis in 52 patients (80%), prehepatic PH in 7 (10.8%), and segmentary PH in 3 (4.6%), and non-classified in 3 (4.6%). Cirrhotic patients were classified as Child A in 21 cases, Child B in 25 and Child C in 6. According to the Sarin classification, 7 patients had gastric-oesophageal varices (GOV) type 1, 32 GOV2, 8 GOV1 and 2, and 8 isolated gastric varices (IGV) type 1. Fifty-six patients (86%) presented active bleeding or stigmata of recent bleeding at time of initial endoscopy. Primary hemostasis was achieved in 50 of them (89%) and the remaining 6 required a second session. Eleven patients presented rebleeding within the following 6 weeks and were again treated with cyanoacrylate. Hemostasis was achieved in 8 of them, 2 were referred for surgical management, and 1 received endovascular treatment. Follow-up was able in 53 patients for an average period of 11 months (range 1 to 81 months). During this period, 7 patients presented an episode ofrebleeding and were treated with cyanoacrylate, achieving hemostasis. Eradication of varices was documented on 21 patients (39.6%). The global rate of rebleeding was 37%. One patient developed splenic vein thrombosis as a major complication of treatment. CONCLUSION: Definitive hemostasis was achieved in 94.6% of patients, with primary hemostasis in 89%. The global rate of rebleeding was 37% and the rate of major complications associated with treatment 0.6%. Eradication of gastric varices was achieved in 35.8% of cases. As these data show, it can be concluded that butyl-cyanoacrylate constitutes an effective method for the treatment of gastric variceal bleeding. SN - 0300-9033 UR - https://www.unboundmedicine.com/medline/citation/22616494/[N_butyl_2_cyanoacrylate_for_the_treatment_of_gastric_varices]_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -