Management of Bleeding Gastric Varices with Histoacryl Glue Injection - Long-Term Outcomes

Abstract

Management of Bleeding Gastric Varices with Histoacryl Glue Injection Long-Term Outcomes Jaber Al Ali, Justin Cheung, Michael Byrne, Scott Whittaker, Urs Stienbreacher, Robert Enns Gastric variceal bleeding is an uncommon life threatening complication of portal hypertension. The management of this complication has not been standardized; however, transjugular intrahepatic portosystemic shunt (TIPS) is widely used in the many centers. Endoscopic treatment with histoacryl glue is another treatment option that can be performed acutely in many endoscopy clinics. As we developed experience with ‘glue’ injection of fundal varices we were unclear of the long term benefit and hypothesized that many of these patients may be dying of other causes. We reviewed our long-term outcomes to determine survival and benefit of histoacryl injection therapy of fundal varices. Methods: A retrospective chart review (2001-2005) inclusive of all patients treated with histoacryl glue injection for bleeding gastric fundal varices. Results: 22 patients were treated with histoacryl glue for bleeding gastric varices. Complete data is pending on three patients; therefore analysis was performed on the remaining 19 patients (13 male). A mean of 3 cc was injected in each patient. Repeat endoscopic examination was performed in most patients but repeat injection was deemed necessary in only 3. No patients suffered a complication from the procedure and all injections were successful in cessation of bleeding with no cases of delayed repeat hemorrhage. At follow up median of 24 months 13 (59%) were alive and functioning with minimal limitations. Conclusion: Short term treatment of bleeding fundal varices with glue has been demonstrated to be helpful, however, in this study, long term outcomes of ‘glue’ injection has a favorable survival which strongly supports aggressive use of this endoscopic modality of therapy. Further data is being collected on remaining patients which we feel is likely to support this mode of therapy.