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

Abstract

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.