Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety

Background: The long-term efficacy and safety of the endoscopic injection o f N-butyl-2-cyanoacrylate (Histoacryl) were evaluated to define its role as the initial treatment for bleeding gastric varices. Methods: Ninety patients with bleeding gastric varices underwent endoscopic injections of Histoacryl for hemostasis within a 6-year period. Histoacryl was injected intravariceally as a 1:1 mixture with Lipiodol. Among the 90 patients, 5 had active bleeding and 85 had recent bleeding. Most of the var ices were large (F2 or F3, 85 cases). The most common locations were the fu ndus and the posterior wall of the proximal body (94.4%). After Histoacryl injection, patients were followed endoscopically with retreatment as necess ary. Results: The rate of hemostasis at 1 week was 94.4%. Recurrent bleeding occ urred in 23.3% of the patients from 3 days to 16 months after the initial i njection. Recurrent bleeding was stopped with reinjections of Histoacryl in 16.7% of the patients. The rate of definitive hemostasis was 93.3% (84 of 90). The treatment failure-related mortality rate was 2.2% (2 of 90). to da te, 35 patients have died, mostly as a result of malignancy or liver failur e, and 55 ave still alive. The determining factor for long-term survival wa s the underlying disease leading to portal hypertension. There were few lon g-term complications except for Histoacryl cast extrusion-related mucosal d efects. Conclusions: Endoscopic injection of Histoacryl is highly effective for the treatment of bleeding gastric varices, with rare complications both acutel y and long term. This treatment modality is appropriate as the first choice for bleeding gastric varices.