Successful treatment of persistent bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric varices bleeding.

late has been used successfully for the he− mostatic treatment of bleeding gastric varices [1]. Various complications asso− ciated with the procedure have been re− ported [2]. The prevalence of infectious complications could range from 4.3 % to 50 %, and most are transient and unevent− ful [3]. Because prolonged and persistent septic complications have been rarely re− ported, the appropriate strategy of man− agement in this situation has become a challenge. A 70−year−old man and a 61−year−old woman with a history of liver cirrhosis underwent local injection of N−butyl−2− cyanoacrylate for bleeding gastric varices. Prolonged and persistent fever with bac− teremia occurred after the procedure de− spite systemic antibiotic administration for more than 1 month. Initial evaluations to determine the source of sepsis were unremarkable in both patients. A gallium scan for unknown fever was carried out and revealed a significant hot spot in the upper middle abdomen in the first patient (l" Figure 1) but not in the second. We repeated esophagogastro− duodenal endoscopy and endoscopic ul− trasonography (EUS) in both patients. The first patient had incomplete obtura− tion of perigastric varices flow (l" Fig− ure 2 a). During the procedure, the inject− ed histoacryl cast fell apart (l" Figure 2 b). Fever subsided dramatically on the same day. In the second patient, we found a soft tissue ball in the gastric varices with blood flow passing through (l" Fig− ure 3 a, b). We injected an additional amount of N−butyl−2−cyanoacrylate to obturate the flow of gastric varices com− pletely (l" Figure 3 c), and then fever sub− sided. From our cases, the cause of persistent fe− ver and bacteremia after tissue adhesive Successful treatment of persistent bacteremia after endoscopic injection of N−butyl−2−cyano− acrylate for gastric varices bleeding