Cyanoacrylate Treatment of Gastric Varices Case Study 1: Recurrent Gastrointestinal Bleeding

Background

A 60-year-old man with cirrhosis secondary to alcoholic liver disease presented with a history of multiple gastrointestinal bleeds over a three-year period. The patient had a history of both esophageal and gastric varices and had undergone multiple episodes of esophageal variceal band ligation. Endoscopic evaluation prior to his referral to California Pacific Medical Center revealed a large gastric varix with evidence of portal hypertensive gastropathy. The patient was not a candidate for a TIPS procedure due to a portal vein thrombosis and was therefore referred for cyanoacrylate therapy.

Treatment

The patient was noted to have a massive multilobulated gastric varix and underwent two separate injections of cyanoacrylate glue. Over the following 12 months, repeat endoscopies revealed obliteration of gastric varix with an obvious glue plug extruding from the injection site. Endoscopic ultrasound confirmed the obliteration of the varix lumen.

Outcome

More than one year after the procedure the patient has had no further gastrointestinal bleeding. The patient developed no complications from the procedure and is feeling well.