Safe and successful endoscopic initial treatment and long term eradication of gastric varices by EUS-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

OBJECTIVE: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. MATERIAL AND METHODS: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated. RESULTS: Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent. CONCLUSION: Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl. DOI: https://doi.org/10.3109/00365521.2014.929171 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-105073 Accepted Version Originally published at: Gubler, Christoph; Bauerfeind, Peter (2014). Safe and successful endoscopic initial treatment and longterm eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection. Scandinavian Journal of Gastroenterology, 49(9):1136-1142. DOI: https://doi.org/10.3109/00365521.2014.929171 Safe and successful endoscopic initial treatment and long term eradication of gastric varices by EUS-guided Histoacryl (N-butyl-2-cyanoacrylate) injection Gubler C, Bauerfeind P Clinic of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland