Clinical Outcomes and Their Determinants in Patients With Gastric Variceal Bleed Undergoing Endoscopic Cyanoacrylate Injection: An Observational Study

Dharanesh Daneti; Kuppusamy Senthamizhselvan; Mamidala R V Chandra; Pazhanivel Mohan; Vikram Kate

doi:10.1016/j.jceh.2023.101315

Clinical Outcomes and Their Determinants in Patients With Gastric Variceal Bleed Undergoing Endoscopic Cyanoacrylate Injection: An Observational Study

J Clin Exp Hepatol. 2024 May-Jun;14(3):101315. doi: 10.1016/j.jceh.2023.101315. Epub 2023 Dec 21.

Authors

Dharanesh Daneti¹, Kuppusamy Senthamizhselvan¹, Mamidala R V Chandra¹, Pazhanivel Mohan¹, Vikram Kate²

Affiliations

¹ Department of Medical Gastroenterology, JIPMER, Puducherry, India.
² Department of Surgery, JIPMER, Puducherry, India.

PMID: 38283706
PMCID: PMC10821593 (available on 2025-05-01)
DOI: 10.1016/j.jceh.2023.101315

Abstract

Background and aims: Gastric variceal bleeding (GVB), compared to esophageal varices, is rare but often massive and associated with high mortality. Endoscopic cyanoacrylate glue injection (ECGI) is the first-line treatment for GVB. Hence, we conducted this study to assess the clinical outcomes and the determinants of ECGI for gastric variceal bleeding.

Methods: This was a prospective observational study of patients with ECGI for GVB between June 2019 and February 2023. The demographic characteristics, etiology and severity of cirrhosis, size, type of gastric varices, volume of cyanoacrylate used, number of sessions required, technical success, rebleeding rate, and survival at three months were studied.

Results: A total of 135 patients underwent ECGI for GVB. Their mean (SD) age was 44.9 (13.6) years, with a male preponderance (n = 23, 68.1 %). Eighty-two patients (60.7 %) had cirrhosis. Their mean model for end-stage liver disease (MELD) score was 14.3 (7.3). Gastric varices were gastroesophageal varices (GOV)1 in 42 (31.1 %), GOV2 in 73 (54.1 %), and isolated gastric varices (IGV)1 in 20 (14.8 %) patients. Varices were large in 35 (25.9 %) and had F1 morphology in 89 (65.9 %) patients. The success rate of initial hemostasis was 98.5 %. The median sessions required were 1 (1-2), and the median volume of cyanoacrylate per session was 2 (1-2) ml. The procedure was associated with minor complications like transient abdominal pain in 11 (8.1 %) and fever in 2 (2.7 %) patients. Rebleeding was observed in 23 (17 %) patients. GOV2, F1 morphology, and a high MELD score were significantly associated with rebleeding. Five (3.7 %) patients died during the study; 2 (1.5 %) were due to failure to control bleeding.

Conclusion: In conclusion, our study demonstrated ECGI to be very safe and effective for GVB. The technical success was high and could be achieved in fewer sessions with a smaller volume of cyanoacrylate during each session.

Keywords: cyanoacrylate; gastric varices; hemostasis.