Treatment of Bleeding Gastric Varices by Endoscopic Cyanoacrylate Injection: A Developing-country Perspective.

Abstract

IntroductionGastric varices (GV) are less commonly seen but bleed more severely than esophageal varices (EV). Transjugular intrahepatic portosystemic shunt (TIPS), alcohol injection, and N-butyl-2-cyanoacrylate (NBCA) are generally used for GV bleed management. NBCA is usually injected endoscopically and is known to be quite successful in the treatment of GV bleeding. This study was conducted with the objective of determining the outcomes in patients with GV treated with NBCA.MethodsWe conducted a retrospective review of medical records and reports of endoscopy performed between March 2015 and June 2018 at a large tertiary care center. Patients of any age and gender having a history of chronic liver disease, those presenting with hematemesis or melena, and those who were found to have GV bleed on endoscopy and treated with NBCA were included. All the endoscopy procedures were undertaken within 24 hours of admission. Informed written consent was obtained from all the patients before the procedure. The outcomes were measured in terms of rate of mortality, hemostasis achieved, duration of stay at the hospital, and requirement of blood transfusion.ResultsA total of 31 patients met the inclusion criteria; (58.1%) were males and 13 (41.9%) were females. The mean age was 55.23 ±8.77 years; 12.9% were Child-Pugh class-A, 64.5% were class B, and 22.6% were class C. Out of the 31 patients, 27 (87%) patients achieved hemostasis. Moreover, 22 (71%) patients had hospital stay ranging between 5-8 days. The overall mortality rate was 9.7% (3 patients). No complication was reported from NBCA injection.ConclusionThe injection of NBCA can provide a safe and effective method for the management of GV bleeding as demonstrated by the results of our study, which showed hemostasis in a majority of the cases after the initial injection with no procedure-related complications, a reduced hospital stay, and a reduced rate of mortality.