Treatment of gastric varices with cyanoacrylate complicated by systemic embolization

Cristina Peixoto de Sousa; Catarina Carvalho; Célia Sousa; Ricardo Amaral

doi:10.47892/rgp.2024.441.1603

Treatment of gastric varices with cyanoacrylate complicated by systemic embolization

Authors

Cristina Peixoto de Sousa Department of Anesthesiology and Pain Therapy, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal. https://orcid.org/0000-0001-9786-6780
Catarina Carvalho Intensive Care Service, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal. https://orcid.org/0009-0004-0395-005X
Célia Sousa Department of Radiology, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal. https://orcid.org/0000-0001-6876-9906
Ricardo Amaral Intensive Care Service, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal. https://orcid.org/0000-0002-8723-4074

DOI:

https://doi.org/10.47892/rgp.2024.441.1603

Keywords:

Cyanoacrylates, Ethiodized oil, Gastric varices, Cerebral embolism

Abstract

Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.

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References

Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, Augustine P. Beyond the scope and the glue: update on evaluation and management of gastric varices. BMC Gastroenterology. 2020;20(1):361. doi: 10.1186/s12876-020-01513-7.

Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343-9. doi: 10.1002/hep.1840160607.

Henry Z, Patel K, Patton H, Saad W. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clin Gastroenterol Hepatol. 2021;19(6):1098-1107.e1.doi: 10.1016/j.cgh.2021.01.027.

Ríos Castellanos E, Seron P, Gisbert JP, Bonfill Cosp X. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev. 2015(5):Cd010180. doi: 10.1002/14651858.CD010180.pub2.

Maydeo A, Patil G. How to Approach a Patient With Gastric Varices. Gastroenterology. 2022;162(3):689-695. doi: 10.1053/j.gastro.2021.12.277.

Chevallier O, Guillen K, Comby PO, Mouillot T, Falvo N, Bardou M, et al. S Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. J Clin Med. 2021;10(11):2298. doi: 10.3390/jcm10112298.

Cheng LF, Wang ZQ, Li CZ, Lin W, Yeo AE, Jin B. Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate. Clin Gastroenterol Hepatol. 2010;8(9):760-6. doi: 10.1016/j.cgh.2010.05.019.

Kok K, Bond RP, Duncan IC, et al. Distal embolization and local vessel wall ulceration after gastric variceal obliteration with Nbutyl-2-cyanoacrylate: a case report and review of the literature. Endoscopy. 2004;36(5):442-6. doi: 10.1055/s-2004-814323.

Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterolo

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Published

03/18/2024

How to Cite

de Sousa CP, Carvalho C, Sousa C, Amaral R. Treatment of gastric varices with cyanoacrylate complicated by systemic embolization. Rev Gastroenterol Peru [nternet]. 2024 Mar. 18 [cited 2024 May 14];44(1):67-70. vailable from: https://revistagastroperu.com/index.php/rgp/article/view/1603

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Issue

Vol. 44 No. 1 (2024)

Section

REPORTES DE CASOS

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Revista de Gastroenterología del Perú by Sociedad Peruana de Gastroenterología del Perú is licensed under a Licencia Creative Commons Atribución 4.0 Internacional..

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