Undiluted N-butyl cyanoacrylate is safe and effective for gastric variceal bleeding.

Abstract

BACKGROUND:

Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. N-butyl cyanoacrylate (NBC), mixed with lipiodol, has been shown to be effective in controlling bleeding, but is associated with the risk of distal embolization.

OBJECTIVE:

To study the efficacy and safety of undiluted NBC in the management of gastric varices (GV).

DESIGN:

Prospective cohort study.

SETTING:

Single tertiary care center.

PATIENTS:

170 consecutive patients with GV.

INTERVENTION:

Standardized technique of undiluted NBC injection for management of GV.

MAIN OUTCOME MEASUREMENTS:

Achievement of initial hemostasis, rate of rebleeding, procedure-related complications, and mortality.

RESULTS:

GV were identified in 170 patients, 87 of whom were treated with 261 injections of undiluted NBC. Among 46 patients with active bleeding of GV, initial hemostasis was achieved in 84.8%. Rebleeding was seen in 23.4% patients over a mean follow-up of 16 months. No case of clinical distal embolization was seen. Large GV size, fundal location, and large esophageal variceal size were predictive of GV bleed. The mortality was 8.8% for all patients with GV; 10.3% for patients with GV treated with NBC, and 7.2% for those with GV not treated with NBC. Child-Pugh status was the only predictor of mortality.

LIMITATION:

Only 1 intervention group.

CONCLUSION:

Undiluted NBC is safe and effective in the management of gastric variceal bleeding.

• Authors: Ajay Kumar, Siddharth Singh, Kaushal Madan, Pramod Kumar Garg, Subrat Kumar Acharya
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 72 Issue 4 Pg. 721-7 (Oct 2010) ISSN: 1097-6779 [Electronic] United States
• PMID: 20883849 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Chemical References

• Enbucrilate

Topics

• Adult
• Enbucrilate (administration & dosage, therapeutic use)
• Esophageal and Gastric Varices (drug therapy, mortality)
• Female
• Gastrointestinal Hemorrhage (drug therapy, mortality)
• Hemostasis
• Humans
• Male
• Middle Aged
• Prospective Studies
• Recurrence
• Young Adult