Gastric variceal obliteration with cyanoacrylate

Gastric variceal obliteration (GVO) with cyanoacrylate is the treatment of choice for acute gastric variceal bleeding. GVO is effective in controlling acute gastric variceal bleeding (haemostasis can be achieved in more than 90% of patients). Compared with both gastric variceal sclerotherapy and ligation, rebleeding after GVO is less frequent, GVO is safer method.

Indications of endoscopic treatment:

1. Active bleeding from gastric varices
2. Gastric varices with stigmata of recent bleeding
3. History of bleeding and presence of gastric varices as the only possible source of bleeding

Tissue glue (N-butyl-2-cyanoacrylate) is acrylic resin. When glu comes into contact with water, it rapidly polymerizes (N-butyl-2-cyanoacrylate is the main ingredient in Super glue). The glue is mixed with Lipiodol and glu-Lipiodol mixture is injected into varix via injection catheter. Immediately after the injection, the glue forms a hard substance that obliterates the lumen and leads to heamostasis. Several weeks after the GOV, the glu is extruded into the stomach. GOV is also a therapeutical modality for secondary prophylaxis of gastric variceal bleeding (prevention of rebleeding). It has been shown that the rebleeding rate is higher in those gastric variceal bleeding patients in whom eradication was not achieved than in those in whom varices were eradicated. Complete eradication of gastric varices can be achieved in several sessions of GVO in high proportion of patients.

Possible complications:

1. cerebral, pulmonary and portal embolization of the glue (instillation of large volume of the mixture and of the glue that is too diluted increases the risk)
2. perforation of the stomach, retrogastric abscess, fistulas (induced by paravariceal injection)
3. pyrexia, bacteraemia
4. needle sticking in the varix
5. adherence of glue to the endoscope