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Updated: Aug 28, 2025
Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
CYANOACRYLATE GLUE FOR GASTROESOPHAGEAL VARICES: A SINGLE CENTRE EXPERIENCE FROM NORTH INDIA
Manjri Garg1, Tarana Gupta2, Sandeep Goyal3
1MD Medicine. Associate Professor, Department of Medicine, Pt. B. D. Sharma PGIMS, Rohtak, Haryana.
Insights
N-butyl 2-cyanoacrylate (NBC) glue is a life-saving therapy for bleeding gastric and esophageal varices. This study shows NBC glue effectively achieved hemostasis in 75 patients, demonstrating its utility in managing difficult variceal bleeding.
Area of Science:
- Gastroenterology
- Endoscopic Therapy
- Hepatology
Background:
- Variceal bleeding is a critical complication of cirrhosis.
- Gastric varices present unique management challenges due to location and bleeding risk.
- N-butyl 2-cyanoacrylate (NBC) glue injection is a promising treatment for bleeding gastric varices.
Purpose of the Study:
- To evaluate the efficacy and safety of NBC glue application in managing gastric and difficult esophageal varices.
- To present clinical experience with NBC glue therapy for variceal bleeding.
Main Methods:
- A total of 75 patients with varices underwent NBC glue application using flexible endoscopy and a sclerotherapy needle.
- The study included 69 patients with gastric varices and 6 patients with esophageal varices.
- Precautionary measures were taken during all procedures.
Main Results:
- Hemostasis was achieved in all patients post-endotherapy.
- Complete obliteration of varices was achieved in 55 patients after a single NBC application session.
- While 20 patients experienced in-hospital mortality (35% at 6 weeks), none were attributed to gastrointestinal bleeding.
Conclusions:
- NBC glue therapy is a life-saving option for patients with bleeding gastric and esophageal varices.
- It is particularly valuable for cases not suitable for endoscopic variceal ligation or sclerotherapy.
- Effective hemostasis and obliteration rates support the use of NBC glue in managing challenging variceal bleeding.
Background:
In natural history of cirrhosis, variceal bleeding is one of the earliest decompensations to happen, and, if adequately managed, survival is improved. Gastric varices have challenges in management due to their location, size and propensity to bleed. The N-butyl 2-cyanoacrylate (NBC) glue application has emerged as definitive therapy in bleeding gastric varices. Here we present our experience with use of NBC in management of gastric and difficult cases of esophageal varices.
Methods:
A total of 75 patients underwent NBC glue application for varices which included 69 patients with gastric varices and six patients with esophageal varices. All the procedures were done with flexible endoscope and sclerotherapy needle after due precautionary measures.
Results:
Hemostasis was varices in all patients after endotherapy. The average quantity of glue used was 2.75±0.95 mL. Complete obliteration with single session of NBC application was achieved in 55 patients. Re-bleeding occurred in five patients within 5 days of index event. 20 patients had in-hospital mortality but none was related to gastrointestinal bleeding. 6-week all-cause mortality was 26 (35%).
Conclusion:
Glue therapy with NBC is a life saving therapy in patients with bleeding gastric varices and esophageal varices not amenable to endoscopic variceal ligation or sclerotherapy.
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