A case of endoscopic hemostasis of gastric variceal bleeding with cyanoacrylate injection is presented along with a discussion on this subject.
Case: A 50-year old woman with cirrhosis presented with active gastric variceal bleeding, which was controlled with the injection of cyanoacrylate in the retroflexed position and in the antegrade position.
Mechanism of action: Physical occlusion of the lumen of gastric varices by the glue.
Special Measures: Unlike sclerotherapy, adherence to the details of injection is critical for successful outcome. 1. Mix Histoacryl with Lipiodol in a ratio of 1:1 to 1:6. 2. Prevent endoscope damage from Histoacryl by coating the endoscope and its channel with silicone oil. 3.Protect the eyes of the patient and the endoscopic staff. 4. Slow injection of small aliquots. 5. At the end of injection, flush the catheter with Lipiodlol or saline.
Outcome: Cyanoacrylate is superior to band ligation in the management of gastric varices ? results in better hemostasis, less rebleeding, and less need for transfusions.
Complications: Local and systemic inflammatory reaction, thromboembolic and septic complications, and damage to endoscope.
Walton Albuquerque, MD, PhD, Universidade Federal de Minas Gerais, Brazil
Edivaldo F. Moreira, M.D., Universidade Federal de Minas Gerais, Brazil
Carlos E. Vilas, M.D., Universidade Federal de Minas Gerais, Brazil
Vitor N. Arantes, M.D., Universidade Federal de Minas Gerais, Brazil
Gottumukkala S. Raju, MD, MD Anderson Cancer Center