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Cyanoacrylate glue for gastrointestinal bleeding.
Frank Weilert1, Kenneth F Binmoeller
1aUnit of Endoscopy, Department of Gastroenterology, Waikato Hospital, Hamilton, New Zealand bPaul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA.
Current Opinion in Gastroenterology
|July 6, 2016
Summary
Endoscopic ultrasound-guided cyanoacrylate (CYA) injection improves gastric varices treatment by ensuring direct intravascular delivery. This method reduces serious adverse events and rebleeding rates, supporting its use for prophylaxis.
Area of Science:
- Interventional Endoscopy
- Gastroenterology
- Vascular Therapy
Background:
- Cyanoacrylate (CYA) therapy is a key treatment for gastric varices.
- Direct endoscopic injection is a first-line therapy but carries risks of serious adverse events.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic ultrasound (EUS)-guided cyanoacrylate injection for gastric varices.
- To compare EUS-guided therapy with traditional free-hand injection methods.
Main Methods:
- Utilizing endoscopic ultrasound to guide the direct intravascular injection of cyanoacrylate (CYA).
- Incorporating vascular coils with or without CYA for enhanced therapy delivery.
Main Results:
- EUS-guided therapy ensures accurate intravascular delivery, overcoming limitations of free-hand injection.
- Published long-term results demonstrate significantly reduced serious adverse events.
- Low rebleeding rates were observed in studies utilizing EUS-guided CYA therapy, with or without coils.
Conclusions:
- Direct endoscopic ultrasound-guided intravascular injection of CYA is increasingly accepted for gastric varices.
- This technique offers reduced complication rates and significantly lower rebleeding rates.
- Evidence supports CYA use for both primary and secondary prophylaxis of gastric varices.