Undiluted N-butyl cyanoacrylate is safe and effective for gastric variceal bleeding.

BACKGROUND

Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. N-butyl cyanoacrylate (NBC), mixed with lipiodol, has been shown to be effective in controlling bleeding, but is associated with the risk of distal embolization.

OBJECTIVE

To study the efficacy and safety of undiluted NBC in the management of gastric varices (GV).

DESIGN

Prospective cohort study.

SETTING

Single tertiary care center.

PATIENTS: 170 consecutive patients with GV.

INTERVENTION: Standardized technique of undiluted NBC injection for management of GV.

MAIN OUTCOME MEASUREMENTS: Achievement of initial hemostasis, rate of rebleeding, procedure-related complications, and mortality.

RESULTS

GV were identified in 170 patients, 87 of whom were treated with 261 injections of undiluted NBC. Among 46 patients with active bleeding of GV, initial hemostasis was achieved in 84.8%. Rebleeding was seen in 23.4% patients over a mean follow-up of 16 months. No case of clinical distal embolization was seen. Large GV size, fundal location, and large esophageal variceal size were predictive of GV bleed. The mortality was 8.8% for all patients with GV; 10.3% for patients with GV treated with NBC, and 7.2% for those with GV not treated with NBC. Child-Pugh status was the only predictor of mortality.

LIMITATION: Only 1 intervention group.

CONCLUSION

Undiluted NBC is safe and effective in the management of gastric variceal bleeding.