Novel Technique for Treating Bleeding Gastric Varices

A new study reports that endoscopic sclerotherapy using cyanoacrylate combined with aethoxysklerol successfully caused bleeding gastric varices to disappear within several months.

Researchers at Jiaotong University (Shanghai, China) treated two patients admitted to Ruijin hospital (Shanghai, China) diagnosed with liver cirrhosis and portal hypertension related to hepatitis infection due to recurrent melena and hematemesis. Upon gastroscope retroflexion examination, isolated gastric varices were observed in the gastric fundus. The researchers then assessed portosystemic collaterals using computerized tomography portal angiography (CTPA) before performing sclerotherapy. The researchers used α-cyanoacrylate alkyl as an adhesive and aethoxysklerol as an eradication agent. Subsequent CTPA revealed the vessels blocked by the adhesive polymer, which was seen as a convincing sign of effective obliteration and elimination of the gastric varices. Both patients were given antacids to suppress the secretion of gastric acid, thus protecting the gastric mucosa and promoting healing of the gastric ulcer. No complications or clinical signs of gastrointestinal re-bleeding were observed during six months of endoscopic follow-up. The study was published in the June 14, 2008, issue of the World Journal of Gastroenterology (WJG).

"Although the optimal treatment for gastric fundal variceal bleeding still remains controversial, the novel sclerotherapy using alpha-cyanoacrylate alkyl combined with aethoxysklerol could be an alternative and feasible method for obliteration and eradication of gastric fundal varices,” concluded lead author Yun-Lin Wu, M.D., and colleagues of the department of gastroenterology.

Cyanoacrylate compounds such as N-butyl-2-cyanoacrylate (histoacryl) have been proven safe and efficient in the in endoscopic treatment of actively bleeding gastric varices. The adhesive polymer--an unabsorbable foreign body in the bed of varices formed after injection--also has a weak effect on promoting organization of the veins. However, ulceration may occur, and the continuous polymer extrusion from the vessel bed several weeks after injection could cause fatal rebleeding. Other rare but serious complications of endoscopic sclerotherapy may include cerebral stroke, pulmonary embolism, portal vein embolism, and splenic infarction.

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Jiaotong University
Ruijin hospital