EVALUATION OF UNDILUTED N-BUTYL-2-CYANOACRYLATE IN THE ENDOSCOPIC TREATMENT OF UPPER GASTROINTESTINAL-TRACT VARICES

Background and Study Aims: Endoscopic obliteration of upper gastrointe stinal tract varices using N-butyl-2-cyanoacrylate has been proposed b y some authors, The aim of the present study was to evaluate prospecti vely the efficacy and safety of this technique, using the undiluted su bstance, in obtaining hemostasis of bleeding upper gastrointestinal tr act varices, as well as definitive eradication of varices located in t he gastric fundus and duodenum. Patients and Methods: We carried out v ariceal injections of N-butyl-2-cyanoacrylate in 80 patients (51 males , 29 females, mean age 68 years, range 19-80) with upper gastrointesti nal tract varices, In 24 patients, the varices were located in the eso phagus, in 54 in the gastric fundus, and in the remaining two they wer e in the duodenum, Forty-eight patients were treated for active varice al bleeding, and the other 32 were treated electively. Results: Hemost asis was achieved in 43 of the 38 patients (89.6%) treated for active variceal bleeding, Eradication was obtained in 49 of the 56 patients ( 87.5%) with gastric or duodenal varices, Overall complications occurre d in II patients (10.4%), In two patients, embolization was found, and in a further two patients it was clinically suspected, but could not be proved, Ten patients (12.5%) died during the treatment period, six due to uncontrolled bleeding, two due to rebleeding, and two due to li ver failure. Conclusions: Endoscopic injection of N-butyl-2-cyanoacryl ate appears to be both safe and effective in the treatment of bleeding gastrointestinal tract varices, The relative value of the undiluted s ubstance versus the diluted one should be further evaluated.