Is N-2-Butyl-Cyanoacrilate A Really Good Option For The Treatment Of Gastric Varices?

Aim: To evaluate the success of hystoacryl in primary hemostasis, rebleeding and erradication of gastric varices. Patients and Methods: Since january 1999 to october 2005, 46 patients with bleeding for gastric varices were treated in our unit with n-2-butyl-cyanoacrylate . A mixture of 0.5 ml of hystoacryl and 0.5 ml of lypiodol was used with a maximum of two ml. per session. Sclerotherapy needles of 21 g, Olympus endoscopes (145 series) and sedation with midazolam were used in all patients. Data was analized by chi-square test. Results: we included 46 patients, 32 males and 14 females with a mean age of 56.13 years, range 18-77 and a median of 55. The patients were clasiffied as Child A 18, Child B 21 and Child C 5; two patients were not classified. According to Sarin classification 15 patients presented GOV 1 varices, 22 GOV 2, 5 GOV 1 y 2 and 4 IGV 1. Forty-five patients (97.8%) had active bleeding or recent bleeding stigmata at the moment of the endoscopy. Primary hemostasis was achieved in 80.4% (37 patients) in agreement with Baveno IV. Nine patients with rebleeding were retreated with hystoscryl. Definitive hemostasis was succesful in 6 of them, 2 were sent to surgical treatment and 1 to endovascular therapy. After the definitive hemostasis the patients were discharged with treatment with propanolol in different dosis. After one year of follow up 7 patients rebleed (15,2%) and they were all successfully treated endoscopically . The gastric varices were erradicated in 15 patients (32.6%) with a recurrence in 6 patients (40 %). Conclusion: In our series primary hemostasis was achieved in 80.4% and definitive hemostasis in 93.47% of the patients. The erradication of gastric varices was obtained in 32.6 %. During the follow up 40% of these patients had a recurrence. We conclude that n-2-butyl-cyanoacrilate is a very good method for the bleeding of gastric varices but it is not recommended for their erradication.