Glue therapy for bleeding gastric varices: a single tertiary center experience in Nepal

Abstract

Introduction: Bleeding is a common presentation in the Department of Gastroenterology, Institute of Medicine, Tribhuvan University Teaching Hospital. Of the varied causes of upper gastrointestinal bleed, bleeding gastric varices pose a major challenge to the endoscopist and the treating physician. Endoscopic injection of N-butyl-2-cyanoacrylate is the standard of care for treating gastric varices at present.

Methods: We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients presenting with gastric variceal bleed. Between May 2016 to April 2017, 25 patients (14-M, 11-F) who presented to Institute of Medicine, Tribhuvan University Teaching Hospital with gastric variceal bleeding underwent endoscopic treatment with N-butyl-2-cyanoacrylate.

Results: Eleven patients had cirrhosis secondary to alcohol, 9 had non-cirrhotic portal hypertension, cirrhosis due to hepatitis B-1, hepatitis C-1, NASH-1, and cryptogenic- 2. Child-Pugh score at presentation for patients was Child A-52%, Child B-36% and Child C-12. Successful hemostasis. rebleeding rate and complications were reviewed. Immediate hemostasis was observed in 100 of the cases and carly rebleeding rate of 8% was seen in 2 patients. Complications included post procedure pain 16%, fever 16% and pulmonary embolism 4%.

Conclusion: N-butyl-2-cyanoacrylate is an effective, lifesaving modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate.