Journal
DIGESTIVE AND LIVER DISEASE
Volume 41, Issue 10, Pages 729-734Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.dld.2009.02.006
Keywords
Acrylate glues; Endoscopic haemostasis; Oesophageal variceal bleeding; Tissue adhesives; Variceal banding
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Background: Acrylate glue injection is seldom performed in patients with bleeding oesophageal varices. Aim: To assess efficacy and safety of acrylate glue injection in patients with bleeding oesophageal varices, as well as the impact of this technique on subsequent variceal ligation. Methods: Prospective study on 133 consecutive cirrhotic patients treated by intravariceal injection of undiluted N-butyl-2-cyanoacrylate into the bleeding varix. Outcome measures were initial haemostasis, recurrent bleeding, complications and mortality at 6 weeks. Results: 52 patients were actively bleeding at endoscopy and 81 showed stigmata of recent haemorrhage. Initial haemostasis was achieved in 49/52 active bleeders (94.2% [95% CI 85.1-98.5]). Overall, early recurrent bleeding occurred in 7 patients (5.2% [95% CI 2.3-10.1]). No major procedure-related complication was recorded. At 6 weeks, death occurred in 11 patients, with an overall bleeding-related mortality of 8.2% [95% CI 5.8-15.3]. Mortality was higher in active (15.4% [95% CI 6.9-28.1]) than non-active bleeders (3.7% [95% CI 0.8-10.4], OR 4.7 [95% CI 1.05-28.7], p = 0.02). Of those surviving the first bleeding episode, 112 patients subsequently underwent ligation. No technical difficulties were encountered in performing the banding procedure which was successfully completed in all cases. Conclusions: Emergency injection of acrylate glue is safe and effective for the treatment of acute bleeding oesophageal varices and does not hamper subsequent variceal (C) 2009 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
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