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Endoscopic Therapy with 2-Octyl-cyanoacrylate for the Treatment of Gastric Varices

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Abstract

Background

Gastric variceal bleeding is associated with significant morbidity and mortality and limited endoscopic therapeutic options.

Aim

The aim of this study was to evaluate the short- and long-term efficacy and safety of endoscopic therapy with 2-octyl-cyanoacrylate in patients with gastric variceal bleeding.

Methods

A single-center retrospective review of patients receiving endoscopic therapy for gastric variceal hemorrhage. Patient demographics, laboratory, and procedural data were collected. Patients were followed to death, liver transplantation, or last follow-up. Success rates were defined as immediate control of bleeding; early re-bleeding (1–7 days), short-term re-bleeding (1–12 weeks), overall survival, and serious procedure complications.

Results

A total of 41 patients (39 with cirrhosis) underwent 54 cyanoacrylate injections during study period. Mean age was 57 and 73 % were males. Twenty-four (58.5 %) patients had failed or were deemed ineligible for transjugular intra-hepatic portosystemic shunt, and 5 % were done for primary prophylaxis. Immediate hemostasis was achieved in five active bleeders. During a median survival time of 117 days, early re-bleeding was seen in 1 (2.4 %), short-term re-bleeding in five patients (12 %), and varices were eradicated in 15 (46.8 %) patients on follow-up. Mean MELD score at the time of the first injection was 17.1 ± 7.8. Mean volume injected was 3.4 cc and median number of varices injected per session was one. Eight patients died during the long-term follow-up: metastatic cancer (2), infections (3), liver failure (1), and re-bleeding (2). There were no serious procedure-related complications.

Conclusions

Endoscopic cyanoacrylate therapy appears effective and safe for treatment of patients with bleeding from gastric varices or high-risk stigmata.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Tennessee College of Medicine, Chattanooga, 979 East Third Street, Suite C-825, Chattanooga, TN, 37403, USA

    Arslan Kahloon

  2. Division of Gastroenterology and Hepatology, Regenstrief Health Center, Indiana University, Room 4100, 1050 Wishard Blvd., Indianapolis, IN, 46202, USA

    Naga Chalasani

  3. Division of Gastroenterology and Hepatology, University Hospital, Indiana University, Room 4100, 550 University Blvd., Indianapolis, IN, 46202, USA

    John DeWitt, Suthat Liangpunsakul, Rakesh Vinayek, Raj Vuppalanchi & Marwan Ghabril

  4. Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98101, USA

    Michael Chiorean

Authors
  1. Arslan Kahloon
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  2. Naga Chalasani
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  3. John DeWitt
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  4. Suthat Liangpunsakul
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  5. Rakesh Vinayek
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  6. Raj Vuppalanchi
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  7. Marwan Ghabril
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  8. Michael Chiorean
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Correspondence to Michael Chiorean.

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Kahloon, A., Chalasani, N., DeWitt, J. et al. Endoscopic Therapy with 2-Octyl-cyanoacrylate for the Treatment of Gastric Varices. Dig Dis Sci 59, 2178–2183 (2014). https://doi.org/10.1007/s10620-014-3148-9

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  • DOI: https://doi.org/10.1007/s10620-014-3148-9

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