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Gursimran Kochhar, MD
Gursimran Kochhar, MD

Poster 879 Safety and Efficacy of Cyanoacrylate Injections for Management of Gastric Varices: A Single Center Experience 

Author Insight from Gursimran Singh Kochhar MD, Cleveland Clinic Foundation

What’s new here and important for clinicians?

Up to 20% of patients with cirrhotic portal hypertension can have gastric varices. Unlike esophageal varices, pathophysiology of gastric varices is not well understood. Although gastric varices tend to bleed less than the esophageal varices, bleeding from gastric varices tends to me more severe and less amenable to therapy. The risk of re bleeding from gastric variceal bleed is higher and mortality can be as high as 30%. Main therapies to manage gastric variceal bleed are transjugular intra hepatic portosystemic shunt (TIPS) or endoscopic injection of cyanoacrylate or glue. Cyanoacrylate injections are performed widely across Europe and Asia with excellent outcomes, but are not widely used in United States and are not currently FDA-approved.

The aim of our study was to demonstrate safety and efficacy of use of glue therapy in management of gastric varices in U.S. population. We retrospectively collected data on patients who underwent glue injection for treatment of gastric varices. A total of 50 patients underwent 98 glue injections at our center from January 2011 to December 2014. Glue therapy was successful in 84 % of patients. Only 3 patients failed glue therapy and had to get TIPS for management of gastric varices in our study. Glue therapy also proved to be safe, as of all 98 glue injections reported, adverse events were limited to 7 incidences of aspiration post procedure, 4 incidences of pulmonary embolism or DVT, and 1 cardiac related adverse event. We also noted a significant reduction of requirement of blood and blood products post glue therapy, which was statistically significant.

Overall, cyanoacrylate injection is safe and effective for treatment of gastric varices, especially in the hands of expert endoscopists. It also reduces the transfusion requirements significantly in these patients with gastric varices.

What do patients need to know?

For patients with Gastric Varices they should consult their doctors and see if they would be good candidates for Glue therapy especially in patients who cannot undergo TIPS procedure.

Read Abstract

Author Contact Gursimran Singh Kochhar MD, Cleveland Clinic Foundation


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