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Background and Aims: Cyanoacrylate has been used for the control of bleeding from gastric varices. The aim of the study was to evaluate the efficacy and the safety of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and to find out the factors related to the failure of therapy, rebleeding, and survival after the therapy. Patients and methods: Sixtyseven patients who treated with n-butyl 2-cyanoacrylate injection therapy for active (spurting or oozing) or recent hemorrhage (adherent clot or fibrin clot over varices) from gastric varices were retrospectively reviewed. Results: Initial hemostasis, defined as complete control of active bleeding, was achieved in all 12 patients. Success of therapy, defined as absence of rebleeding or death during the 5 days after the therapy, was achieved in 88% of patients. A stepwise logistic regression analysis including age, sex, cause of cirrhosis, Child-Pugh class, variceal form, bleeding site (cardia or fundus), initial hemoglobin and presence of hepatocellular carcinoma as variables indicated that only the Child-Pugh class was an independent predictive factor of treatment failure (Odds ratio, 14.7; 95% CI, 1.69-128.4; P = 0.015). Rebleeding occurred in 13 patients (19%) during 4 weeks after the therapy. The actuarial probability of 4-week remaining free of rebleeding after initial therapy was 77.6% and it was significantly higher in patients with Child-Pugh A and B than in patients with Child-Pugh C (95.1% vs 50%; P = 0.0001). Mortality at 4 weeks was 15%. A stepwise logistic regression analysis including the same variables used for failure of therapy indicated that the Child-Pugh class (Odds ratio, 16.8; 95% CI, 1.8- 154.5; P = 0.01) and the presence of hepatocellular carcinoma (Odds ratio, 14; 95% CI, 1.5-130.3; P = 0.02) were the independent predictive factors of mortality at 4 weeks. The actuarial probability of survival at 4 weeks after initial therapy was 85.1%. There were 2 cases (2.7%) of major complications due to cyanoacrylate embolism (pulmonary embolism and splenic infarction). However these complications spontaneously resolved and caused no death. Transient fever was found in 10.4% of patients. Conclusion: N-butyl 2-cyanoacrylate injection therapy is highly effective in the management of bleeding from gastric varices. Child-Pugh class is an important predictive factor of treatment failure, rebleeding, and survival after the therapy. |
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