Endoscopic Treatment of Gastric Varices: Histoacryl Method

Abstract

The endoscopic injection of cyanoacrylate glue (Histoacryl) has been successfully used to obliterate gastric varices in various parts of the world. To perform this treatment safely and effectively, the Histoacryl should be diluted with 5% Lipiodol (1:1) to lengthen the cyanoacrylate polymer and allow fluoroscopic monitoring. A mixture of Histoacryl and 5% Lipiodol should be injected to fill the gastric varices and the juxta-variceal portions of their inflow/outflow veins. Most gastric varices consist of a single varicose vessel and can be successfully obstructed with two injections. In the case of large gastric varices consisting of multiple varices, Histoacryl should be injected not only into the main varices but also into any small varices and connecting ramifications. The fluoroscopic monitoring of the injection procedure is very important for reducing the risk of complications and ensuring that gastric varices are completely obliterated. Assessments of variceal anatomy might provide useful clinical information that will lead to improvements in the treatment strategies for such patients. The endoscopic injection of cyanoacrylate glue (Histoacryl) under fluoroscopic guidance can rapidly halt life-threatening gastric variceal bleeding and remove patients’ long-term fears regarding the risk of rebleeding.