Clinical evaluation of endoscopic injection sclerotherapy using n-butyl-2-cyanoacrylate for gastric variceal bleeding

Background: Emergency endoscopic injection sclerotherapy (EIS) has been app lied to the initial treatment of gastric variceal bleeding and various meth ods have been attempted. Methods: Emergency EIS was performed on 38 patients with gastric variceal b leeding using either the ethanolamine oleate (EO) method or n-butyl-2-cyano acrylate (Histoacryl) method and the outcome was compared. Results: Complete haemostasis was defined as continuous haemostasis lasting for 14 days or more. Complete haemostasis was achieved in 52.4% of patient s in the EO method versus 100% of those treated with the Histoacryl method, a significant difference, suggesting that the Histoacryl method was superi or for achieving haemostasis in an emergency. The cumulative non-bleeding r ate was also significantly higher in patients treated with Histoacryl, indi cating the durability of haemostasis. There were no serious complications i n patients who received either method of sclerotherapy. Post-EIS surgery wa s required in 42.8% of patients treated with EO, while no surgery was requi red in those treated with Histoacryl, supporting the greater haemostatic ef fect of Histoacryl. Although there was no significant difference in the cum ulative survival rates of patients treated by these two methods, death from haemorrhage was avoided by using Histoacryl. Conclusions: Based on these results, the Histoacryl method is thought to be the initial treatment of choice for gastric variceal bleeding, because it achieved superior haemostasis compared with EO and death by haemorrhage was avoided.