Endoscopic Treatment of Gastric Varices: α-Cyanoacrylate Monomer Method

  • Katsutoshi ObaraEmail author


Massive bleeding from gastric varices is a life-threatening event requiring immediate hemostatic measures, which is not easy to predict. However, as large bulging varices and those exhibiting signs of erosion or red color signs are at particularly high risk of bleeding, such varices should be treated proactively even where there is no history of bleeding. For the treatment of bleeding gastric varices, injection of α-cyanoacrylate monomer (αCA) has been performed in Japan as a safe and effective procedure because of its significant hemostatic effect. However, as rebleeding often occurs after the initial bleeding has been stopped with αCA injection, the application of an elective treatment is important. To prevent recurrence after elective or prophylactic treatment, it is essential to obliterate not only the varices but also their blood supply routes by means of αCA-ethanolamine oleate combination therapy, where endoscopic ultrasonography and three-dimensional computed tomography play important roles in the preprocedural study of portal hemodynamics and in the postprocedural evaluation of the outcomes. Furthermore, application of the consolidation method is essential to further reduce recurrence over an extended period.


Gastric varices α-Cyanoacrylate monomer αCA method αCA-EO combination method Consolidation method (mucosal fibrosis method) 


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Advanced Gastrointestinal EndoscopyFukushima Medical UniversityFukushimaJapan

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