Low Incidence of Complications From Endoscopic Gastric Variceal Obturation With Butyl Cyanoacrylate

Background & Aims

Endoscopic variceal obturation with tissue adhesive is used to control gastric variceal bleeding. We investigated the prevalence of serious complications from this therapy.

Methods

We performed a retrospective analysis of complications that occurred in 753 patients with gastric variceal hemorrhages who were hospitalized in 2 tertiary referral hospitals. All patients received N-butyl-2-cyanoacrylate as therapy for endoscopic variceal obturation.

Results

Complications occurred in 51 patients. Thirty-three patients experienced rebleeding because of early-onset (within 3 months) extrusion of the N-butyl-2-cyanoacrylate glue cast (4.4%), 10 patients developed sepsis (1.3%), and 5 patients developed distant embolisms (0.7%; 1 pulmonary, 1 brain, and 3 splenic). One patient had major gastric variceal bleeding after endoscopic variceal obturation (0.1%), 1 developed a large gastric ulcer (0.1%), and 1 had mesentery hematoma, hemoperitoneum, and infection in the abdominal cavity (0.1%). The complication-related mortality was 0.53% (3 deaths from sepsis and 1 death from rebleeding after early-onset glue cast extrusion).

Conclusions

The occurrence of complications after endoscopic variceal obturation with N-butyl-2-cyanoacrylate in gastric varices treatment is rare.

Keywords: Gastric Variceal Obliteration, Histoacryl, Recurrent Variceal Bleeding, Ectopic Embolism

Abbreviations used in this paper: BSH, Beijing Shijitan Hospital, CI, confidence interval, CT, computed tomography, EVL, endoscopic variceal ligation, EVO, endoscopic variceal obturation, EVS, endoscopic variceal sclerotherapy, GHCPLA, General Hospital of Chinese People's Liberation Army, GOV, gastroesophageal varices, IGV, isolated gastric varices, TIPS, transjugular intrahepatic portosystemic shunt