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Updated: Jun 27, 2026
Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
Published on: June 13, 2025
Cyanoacrylate glue in the management of gastric varices
P Consolo1, C Luigiano, G Giacobbe
1Department of Medicine, University Hospital G. Martino, Messina, Italy. carmeluigiano@libero.it
Insights
Cyanoacrylate injection effectively treats actively bleeding gastric varices (GV) and prevents re-bleeding, offering a safe first-line endoscopic therapy. This method achieves high obliteration rates with lower complication and mortality risks compared to other treatments.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Endoscopic Therapy
Background:
- Gastric varices (GV) present a significant management challenge due to severe bleeding and high mortality rates.
- Effective treatment strategies for GV bleeding are crucial, often requiring a multidisciplinary approach.
Purpose of the Study:
- To evaluate the efficacy and safety of cyanoacrylate injection for treating acute gastric varices bleeding.
- To assess the role of cyanoacrylate in the secondary prophylaxis of gastric varices re-bleeding.
Main Methods:
- Intravariceal injection of cyanoacrylate to obliterate the variceal lumen.
- Comparison of cyanoacrylate with other endoscopic techniques like band ligation and sclerotherapy.
- Analysis of re-bleeding rates and complication profiles.
Main Results:
- Cyanoacrylate injection achieves over 80% primary obliteration rates for acute GV bleeding.
- It demonstrates higher effectiveness and lower complication/mortality rates than alternative endoscopic methods.
- Secondary prophylaxis shows a re-bleeding incidence of 15-30%.
Conclusions:
- Endoscopic cyanoacrylate treatment is a safe and effective first-line therapy for actively bleeding GV.
- It is also effective for secondary prophylaxis, reducing re-bleeding risk.
- Current evidence does not support its use in primary prophylaxis for GV bleeding.
Abstract:
Gastric varices (GV) are less common than esophageal varices, but their management represents a particular challenge. When bleeding occurs is usually severe, requiring immediate supportive intensive care and has a high mortality rate. The best management of GV is supposed to be with a multidisciplinary approach and close cooperation between gastroenterologists, interventional radiologists and the surgical team. Many studies in literature reported high success rates with intravariceal injection of cyanoacrylate in acute GV bleeding. This agent obliterates the variceal lumen by solidification within the vein and more than 80% primary obliteration rates are achieved. In comparison with other endoscopic techniques as variceal band ligation or sclerotherapy with ethanolamine oleate, alcohol and sodium tetradecyl sulphate, cyanoacrylate has shown to be more effective, with a decrease in complications and mortality rates. The cyanoacrylate has shown effective also in the secondary prophylaxis with an incidence of re-bleeding that ranges between 15% and 30%. Actually, there is no scientific evidence supporting the application of cyanoacrylate in primary prophylaxis of bleeding from GV. Significant procedural, septic and embolic complications have been reported with cyanoacrylate glue injection. In conclusion, the endoscopic treatment with cyanoacrylate of actively bleeding GV, as well as the prophylaxis of the re-bleeding, is a safe and effective procedure and should be considered as a first-line therapy, whenever available.
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