Gastric Varices Treated with New Glue Injection Procedure
California Pacific and Mayo Clinic Only U.S. Centers Offering Cyanoacrylate Treatment for Gastric Varices
by Kenneth Binmoeller, M.D. and Laura Miyashita
Cyanoacrylate glue injection, a treatment used for years in neurological and ophthalmology procedures and in treatment of cerebral aneurysms, is now offering promise for patients with gastric varices. Pioneered by Kenneth Binmoeller, M.D., director of California Pacific's Interventional Endoscopy Service, and Nib Soehendra, M.D. in Hamburg, Germany, this 'super glue' substance, which is similar in consistency to water, rapidly transforms into a hard, solid substance when added to a physiological medium such as blood.
Gastric varices develop in roughly 25% of patients with portal hypertension and represent about 10% of bleeding sites in variceal hemorrhage. "With this new procedure, the cyanoacrylate glue is injected into the gastric varix, then disperses within the lumen, ultimately plugging the varix," explains Binmoeller. He adds, "This enables not only rapid termination of active bleeding, but also prevents rebleeding from the treated varix." The elmination of varices is usually achieved with a single treatment. Over time, the cyanoacrylate is expelled from the varix lumen, leaving scarred mucosa behind.
The use of cyanoacrylate glue for gastric varices is expected to overcome the shortfalls of transjugular intrahepatic portal shunt (TIPS) treatment. While TIPS is the standard treatment for gastric varices in the U.S., recurrent bleeding is high, ranging from 29% to 53%. In comparison, rebleeding rates following cyanoacrylate glue injection range between 5% to 25%. TIPS also requires an open and adequately sized portal vein. Other procedures used successfully for esophageal varices, such as band ligation and sclerotherapy, are not effective for gastric varices and may result in severe complications.
Numerous studies have validated the safety and efficacy of cyanoacrylate for the treatment of gastric varices and the procedure has been in clinical use in Europe, Asia and the Middle East for over a decade.
For more information on cyanoacrylate treatment for gastric varices or our Interventional Endoscopy Services, call our Specialty Referral Program at 1 (888) 637-2762.