A 69-year-old woman had a history of liver cirrhosis related to chronic hepatitis C. She underwent endoscopic ligation for esophageal variceal bleeding in February 1996, and injection of endoscopic tissue glue (a mixture of 0.5 ml N -butyl-2-cyanoacrylate with 0.5 ml Lipiodol) for gastric variceal bleeding in November 1998. Gastric variceal hemorrhage recurred in December 1999. An emergency endoscopic tissue glue injection was performed, and the bleeding stopped immediately. Another two injections were given to eradicate the residual gastric varices. However, the mixture of the last injection extruded immediately. Because the bleeding stopped, the endoscope was removed.
The patient complained of dysphagia soon after the tissue glue injection, and administration of acetaminophen or prokinetic agents did not relieve this. A follow-up endoscopy revealed an extrusion of tissue glue that had formed a foreign body trapped in and occluding the lower esophagus (Figure [1
Figure 1 The endoscopic image shows a firm foreign body (tissue glue) trapped in the lower esophagus
Variceal injection of tissue glue has been more effective than conventional sclerosants in the treatment of acute gastric variceal bleeding [1 2 3 4 1
If dysphagia occurs after tissue glue injection for gastric variceal bleeding, esophageal impaction of the tissue glue should be considered. If this happens, the foreign body can be removed using an endoscopic Dormia basket.
