Korean J Gastroenterol.  2004 Mar;43(3):186-195.

Therapeutic Effect of the Endoscopic N-butyl-2-cyanoacrylate Injection for Acute Esophagogastric Variceal Bleeding: Comparison with Transjugular Intrahepatic Portosystemic Shunt

• Noh DY
• Park SY
• Joo SY
• Park CH
• Lee WS
• Joo YE
• Kim HS
• Choi SK
• Rew JS
• Kim SJ

Abstract

BACKGROUND/AIMS: Though endoscopic therapies such as variceal ligation and sclerotherapy has been performed, bleeding from the large esophageal and gastric varices still poses significant risk of death. Decrease of portal pressure by TIPS (transjugular intrahepatic portosystemic shunt) or surgical shunt was indicated as cause of failure of endoscopic therapies. Treatment of N-butyl-2-cyanoacrylate has been especially effective for gastric variceal bleeding, but comparison with other treatments had not been reported yet. In this study, the effect of cyanoacrylate injection therapy was cross-examined with the result of TIPS in acute esophagogastric variceal bleedings. METHODS: From April 1995 to June 2002, endoscopic cyanoacrylate injection therapy (43 cases) and TIPS (63 cases) were performed in our hospital. Each group was analysed regarding their clinical results including initial hemostasis rate, rebleeding rate, survival duration, mortality and morbidity. RESULTS: Initial hemostasis rate was 95.3% in cyanoacrylate group and 92.1% in TIPS group. Cumulative probability of rebleeding was not different between two groups. Overall complication rates associated with the procedure were 50.8% in TIPS group and 9.3% in cyanoacrylate group. There was no significant difference between two groups in their survival rates. CONCLUSIONS: Cyanoacrylate injection therapy was relatively safe, and has comparable results with TIPS for uncontrollable and severe esophagogastric variceal bleedings.

Keyword

Esophagogastric varix; Cyanoacrylate; TIPS

MeSH Terms

Acute Disease
Comparative Study
Enbucrilate/*administration & dosage/*analogs & derivatives
Endoscopy, Digestive System
English Abstract
Esophageal and Gastric Varices/surgery/*therapy
Female
Gastrointestinal Hemorrhage/*therapy
*Hemostasis, Endoscopic
Humans
Injections
Male
Middle Aged
*Portasystemic Shunt, Transjugular Intrahepatic
Tissue Adhesives/*administration & dosage