Cyanoacrylates variceal bleeding

Dhiman, R.K., Chawla, Y., Taneja, S., Biswas, R., Sharma, T.R., Dila-wari, XB. Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate. J. Gastroenterol. Hepatol. 2002 35 222-227... 

Sun JJ, Yeo W, Suen R, et al. Injection sclerotherapy for variceal bleeding in patients with hepatocellular carcinoma cyanoacrylate versus sodium tetradecyl sulphate. Gastrointest Enclose. 1998 47 235-239. 

Maluf-Filho F, Sakai P, Ishioka S, Matuguma SE. Endoscopic sclerosis versus cyanoacrylate endoscopic injection for the first episode of variceal bleeding a prospective, controlled, and randomized study in Child-Pugh class C patients. Endoscopy. 2001 33 421-427. 

Injection therapy with cyanoacrylates is now the first line of endoscopic intervention for bleeding gastric varices as well as secondary prevention of gastric variceal bleeds outside of the United States [63]. 

Several randomized controlled smdies have demonstrated that injection of cyanoacrylate is comparable to sclerotherapy in the endoscopic hemostasis of acute variceal bleeding and prevention of rebleeding [65—67]. 

N. N-butyl-2-cyanoacrylate (Histoacryl) plus sclerotherapy versus sclerotherapy alone in the treatment of bleeding esophageal varices a randomized prospective study. Endoscopy 1995 27 355—357... 

Thakeb, F., Salama, Z., Raouf, T.A., Kader, SA., Hamid, H.A. The value of combined use of N-butyl-2-cyanoacrylate and ethanolamine oleate in the management of bleeding oesophagogastric varices. Endoscopy 1995 27 358-364... 

A 58-year-old man had bleeding gastric varices injected with a 50/50 mixture of enbucrilate and lipiodol, but a follow-up X-ray showed radiopaque material in the left lobe of the liver and a CT scan showed cyanoacrylate embolization via the right gastric vein into the main and left portal veins [32 ]. A CT scan 2 years later showed atrophy of the left-lateral segment of the liver, with portal-vein thrombosis and little residual lipiodol retention. 

A 62-year-old man had bleeding gastric varices injected with enbucrilate (Histoacryl ) and 4 weeks later developed hepatic impairment associated with cyanoacrylate in the aorta and iliac arteries [39 ]. He then developed a diffuse ascending spondylodiscitis, with osteolysis of the fifth lumbar vertebra, probably as a result of septic emboli and died 10 months later. 

Hamad N, Stephens J, Maskell GF, Hussaini SH, Dalton HR. Case report. Thromboembolic and septic complications of migrated cyanoacrylate injected for bleeding gastric varices. Br J Radiol 2008 81(971) e263-5. 

Chang CJ, Shiau YT, Chen TL, Hou MC, Sun CH, Liao WC, Lin HC, Lee SD. Pyogenic portal vein thrombosis as a reservoir of persistent septicemia after cyanoacrylate injection for bleeding gastric varices. Digestion 2008 78(2-3) 139-A3. 

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