Use of Histoacryl glue for acutely bleeding oesophageal varices.
AuthorsLayard BV, McDougall NI, Cash WJ
Departments / InstitutionsRoyal Victoria Hospital, Belfast
Publication DateSpring 2014
Variceal haemorrhage is associated with significant morbidity and mortality in patients with liver cirrhosis. When band ligation fails, there are limited therapeutic options in certain patients. The use of Histoacryl glue injection for primary control of bleeding gastric varices is well published. There is little literature describing Histoacryl glue injections in bleeding oesophageal varices. To assess safety and efficacy of Histoacryl glue injection in patients with bleeding oesophageal varices.
We performed a retrospective analysis of cases from a single-centre over 3 years, identifying 8 patients in whom Histoacryl glue injection was attempted for bleeding oesophageal varices. Outcome measures included initial haemostasis, recurrent bleeding, complications, mortality, results of follow-up OGD and 1-year survival.
Of the 8 patients receiving glue injection, indications were: In 6 of the 8 patients (75%), haemostasis was achieved with glue injection, 5/83.3% of which experienced no complications. 1 patient developed Klebsiella sepsis from a small injection site fistula relating to the oesophageal varix injection but subsequently recovered. 2 of the 8 patients died from recurrent bleeding, one a late rebleed at day 7. Of the 6 patients in whom haemostasis was achieved, initial follow up OGD revealed barely noticeable or eradicated varices in 4 patients and varices requiring rebanding without complication in 2 patients. 1-year survival in these 6 patients was 100%.
Use of Histoacryl glue injection in the management of bleeding oesophageal varices is safe and efficacious, particularly in patients unsuitable for a TIPS procedure where conventional endoscopic methods have failed.