The effects of emergent endoscopic variceal sclerotherapy combined with acrylate glue injection on esophageal variceal bleeding

Background: To evaluate the hemostatic effects of emergent Eendoscopic Variceal Sclerotherapy (EIS) combined with acrylate glue (N-butyl-2-cyanoacrylate, NBCA) injection (ESCI) on esophageal variceal bleeding, and to investigate glue extrusion after endoscopic injection. Methods: The rate of hemostasis and blood transfusion in patients that received ESCI were compared to 16 patients who received intervention therapy following the failure of endoscopic treatment. The glue extrusion time and complications of ESCI were also analyzed. Results: Of the 30 patients that received ESCI therapy no heterotopic embolism or serious infection. Transient fever was found in 6 cases, dysphagia in 9 cases and severe dysphagia in 2 that were treated by endoscopy. NBCA (1~4 vials, mean 2.03 ± 0.182 vials) was injected into esophageal varices and glue extrusion from varices was started at 2 weeks (9 cases, 36%) to 3 weeks (15 cases, 60%) after the injection, completed at week 2~4 (88%). In patients receiving interventional therapy, no significant difference was found in the rate of hemostasis. Conclusion: ESCI can effectively control acute esophageal variceal bleeding without heterotopic embolism. However, early glue extrusion could cause esophageal obstruction.