Procedures
Glue Injection In Gastric Varices
- Gastric varices are enlarged veins found in the stomach. They also occur in portal hypertension. . While gastric varices bleed less frequently than esophageal varices, the severity of bleeding and associated mortality is greater. Cyanoacrylate glue is a liquid substance with the consistency of water that transforms into a solid state when added to a physiological medium such as blood. When instilled into a varix using the standard method of intravariceal injection, the glue undergoes an instantaneous polymerization reaction and hardens to a rock hard substance, thereby plugging the lumen of the varix. This enables rapid hemostasis of active bleeding and prevents rebleeding.
- A therapeutic gastroscope with a large working channel is used for injection. Variceal injection is performed with a 23-gauge disposable sclerotherapy needle. The varix is punctured under direct visualization and approximately 1cc of the glue is injected intravariceally. After injection, the patency of the varix is assessed with blunt catheter palpation and additional glue injected until the varices are obliterated.
- Numerous studies from around the world with over 1,000 treated patients have reported control of active variceal bleeding in 93-100% of patients with rates of recurrent bleeding around 10%.
- Cyanoacrylate compounds are routinely used in different medical and surgical subspecialties for embolization of aneurysms, arteriovenous malformations and fistulae, and as a wound or tissue adhesive. The safety profile of cyanoacrylate glue for varix obliteration is excellent. A minority of patients develop transient fever and pain after injection. There have been rare case reports of complications related to embolization, which include cerebral stroke and pulmonary embolism. Visceral fistulas have also been reported, probably due to misguided injections.
- Prophylactically treat patients with varices >1 cm with either red signs or advanced liver disease (Child B or C). The one-year risk of bleeding in a Child C cirrhotic with red marks on a large fundal varix is estimated at 65%.
Patient preparation for the procedure
Preparation for Glue Injection is fasting for 6-8 hours similar to performing a regular esophagogastroduodenoscopy (EGD). An intravenous line is placed to deliver sedation or other medications.
Dr. Kunal Das
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