Cyanoacrylate injection treatment for extraoesophageal variceal bleeding

Background and aims: Endoscopic obliteration of bleeding extraoesophageal varices using N-butyl-2-cyanoacrylate (Histoacryl) has been validated by several authors. The aim of the present study is to describe the intravariceal injection technique using cyanoacrylate and to present the own results and complications observed in conjuction with the haemostatic treatment. Patients and methods: A total of 6 intravariecal injection tretments of N-butil-2-cyanoacrylate were performed in 5 patients (4 males, 1 females, mean age 60.4 years) with extraoesophageal variceal bleeding. In all cases the bleeding varices were located in the gastric fundus Four variceal bleeders under subintensive care were treated early electively with 1:1 ratio cyanoacrylate-lipiodol intravariccal injection (1ml) solutions. Two patients were actively bleeding during the procedure. These patients after Intensive Care Unit treatment got 2–3ml of cyanoacrylate therapy injections. The injection needle was inserted trough a standard endoscope. Results: Early haemostasis was achieved in all patients (5/5) and 1 early rebleeding occurred. In one case because of repeated episod of late recurrent bleeding 1 more injection treatment was performed. There was no mortality due to acute bleeding while one patient died because of hepatic failure during the follow up period.

Conclusions: Endoscopic injection of diluted cyanoacrylate and lipiodol appears to be an effective and safe treatment method of the extraoesophageal variceal bleeding. Injection treatment in an early elective fashion can be performed with the standard schlerotherapy equipments. The necessary quantity of cyanoacrylate for bleeding is also influenced by the intensity.