Endoscopic Cyanoacrylate Injection with Post-injection Audible Doppler Assessment of Gastric Varices: A Single-Institution Experience
Background and Aims
Gastric varices (GV) have higher rates of morbidity and mortality from hemorrhage than esophageal varices. Several studies have shown the safety and efficacy of cyanoacrylate (CA) injection for acute gastric variceal hemorrhage. We report data from our experience with CA injection for GV before and after routine use of post-injection audible Doppler assessment (ADA) for GV obturation and describe long-term outcomes after this therapy.
We retrospectively identified patients who had documented GV, underwent CA injection, and had at least 2 weeks of follow-up. We recorded and analyzed the survival and rebleeding rates with patient demographics, clinical data, and endoscopy findings between two groups of patients who were categorized by CA injection prior to and after inception of the ADA technique.
Seventy-one patients were identified with 16 patients analyzed in a group where ADA was not used (Pre-ADA) and 55 analyzed where ADA was used (Post-ADA). No rebleeding events were observed within 1 week of initial CA injection. No embolic events were reported after any initial CA injection within 4 weeks. The rate of bleed-free survival at 1 year was 69.6% in the Pre-ADA group and 85.8% in the Post-ADA without statistical significance. The all-cause 1-year mortality was 13.8% in the Pre-ADA group and 10.7% in the Post-ADA group without statistical significance.
ADA of CA-injected GV does not appear to significantly affect adverse events or clinical outcomes; however, our findings are limited by small sample size and cohort proportions allowing for significant type II statistical error. Further prospective investigation is required to determine the impact of ADA on clinical outcomes after GV obturation.
KeywordsGastric varices Cyanoacrylate Gastric variceal hemorrhage Audible Doppler Endoscopic Doppler Doppler probe
Audible Doppler assessment
Balloon-occluded retrograde transvenous obliteration
Esophageal variceal hemorrhage
Endoscopic variceal ligation
Gastric variceal hemorrhage
Model for end-stage liver disease
Non-cirrhotic portal hypertension
Portal vein thrombosis
Transjugular intrahepatic portosystemic shunt
Tom D. Catron—Acquisition, analysis, and interpretation of data, drafting of manuscript. George B. Smallfield—Study concept and design, critical revision of the manuscript for intellectual content, administrative and material support, study supervision. Le Kang—Statistical Analysis. Richard K. Sterling—Critical revision of the manuscript for intellectual content. Mohammad S. Siddiqui—Critical revision of the manuscript for intellectual content.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to disclose.
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