Endoscopic histoacryl injection combined with ligation in the treatment of severe esophageal and gastric varices

Cai Jin-wei; Zhou Ying-sheng

doi:10.3969/j.issn.2095-4344.2015.12.017

Abstract：BACKGROUND:As a commonly used tissue adhesive in China, histoacryl can produce transient polymerization and rapidly solidify biological tissue, and it has good prospect in treatment of esophageal and gastric varicose bleeding. OBJECTIVE: To explore the short- and long-term clinical efficacy of endoscopic histoacryl injection combined with ligation for the treatment of esophageal and gastric varices. METHODS: Ninety patients with esophageal and gastric varices were treated by endoscopic adhesive injection and dense ligation. There were 64 males and 26 females, aged 22-75 years. At 2-4 weeks post-treatment, patients were re-checked under an endoscope. The short-term efficacy and adverse reactions, such as the hemostasis rate, varicose vein, varicose vein diameter, red color sign and portal hypertension gastropathy were observed. Al patients were folowed up for 3-39 months after varicose vein was eradicated, to monitor the middle- and long-term clinical efficacy, including varicose vein, tissue adhesive discharging and local proliferation, rebleeding, recurrence and complications. RESULTS AND CONCLUSION: (1) Short-term efficacy: The number of varicose veins significantly reduced, red color signs reduced, and portal hypertension gastropathy improved (P< 0.01), but three cases appeared early rebleeding. The adhesives began to discharge from 2 weeks to 3 months post-treatment, no case appeared esophageal stenosis, perforation, severe infection, heterotopic embolism and other injection-related complication. (2) Middle- and long-term efficacy: varicose vein recurred in nine cases and five cases developed long-term rebleeding. Experimental findings indicate that, endoscopic histoacryl injection combined with ligation is effective to treat severe esophageal varices or (and) bleeding, with high success rate and good hemostasis effect, and it also prevents long-term rebleeding and recurrence.