Post written by Pankaj N. Desai, MS, FASGE Gastro, from the Department of Endoscopy & Endosonography, and the Department of Clinical Research, Surat Institute of Digestive Sciences (SIDS), Surat, India.
Our video describes a simple technique of injection of cyanoacrylate glue for the management of gastric variceal bleed. We use 0.5ml aliquots of n butyl 2 cyanoacrylate glue without lipiodol. Injections are done in gastric varices using a 23G needle starting from the point of origin of the varix off the gastric wall to the part with maximum bulge. We inject 1.5 to 3ml of distilled water immediately following the glue depending on the size of the varix. The amount of glue required is unrestricted, and we inject as much glue as needed until the varix becomes engorged and solid. This protocol has given us very good results with fast obliteration of gastric varices with minimal post-glue ulcerations and recurrent bleeds. We have had no embolism in our large series of 2299 cases.
This video shows how simple the technique of glue injection is. It also gives tips on prevention and management of adverse events related to glue injections. We feel that by way of this video we can encourage our colleagues to learn and practice the art of glue injection and save as many patients as possible who present with gastric variceal bleeds. We also want to bring forth the fact that expensive modalities like TIPSS, BRTO, and EUS-guided coiling can be reserved for refractory bleeders only as in a vast majority of cases in daily practice cyanoacrylate glue is very efficient if used correctly.
From our experience with this technique of glue injection, our colleagues can take a cue that 1ml or bigger aliquots of glue are not needed even if we have F2 gastric varices. Injecting a little more distilled water helps filling of the varix with the glue cast without embolization and gives excellent results. They can also learn a few tricks for safe glue injection and management of adverse events like spurting from injection site, needle getting stuck in the varix, and glue splashing into the operator’s eyes.
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