Seewald Stefan, Ang Tiing Leong, Imazu Hiroo, Naga Mazen, Omar Salem, Groth Stefan, Seitz Uwe, Zhong Yan, Thonke Frank, Soehendra Nib
Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Gastrointest Endosc. 2008 Sep;68(3):447-54. doi: 10.1016/j.gie.2008.02.050.
N-butyl-2-cyanoacrylate has been successfully used for the treatment of bleeding from gastric fundal varices (FV). However, significant rebleeding rates and serious complications including embolism have been reported.
Our purpose was to analyze the safety and efficacy of N-butyl-2-cyanoacrylate for FV bleeding by using a standardized injection technique and regimen.
Retrospective.
Two tertiary referral centers.
A total of 131 patients (91 men/40 women) with FV underwent obliteration with N-butyl-2-cyanoacrylate by a standardized technique and regimen.
(1) Dilution of 0.5 mL of N-butyl-2-cyanoacrylate with 0.8 mL of Lipiodol, (2) limiting the volume of mixture to 1.0 mL per injection to minimize the risk of embolism, (3) repeating intravariceal injections of 1.0 mL each until hemostasis was achieved, (4) obliteration of all tributaries of the FV, (5) repeat endoscopy 4 days after the initial treatment to confirm complete obliteration of all visible varices and repeat N-butyl-2-cyanoacrylate injection if necessary to accomplish complete obliteration.
Immediate hemostasis rate, early rebleeding rate, bleeding-related mortality rate, procedure-related complications, long-term cumulative rebleeding-free rate, and cumulative survival rate.
Initial hemostasis and variceal obliteration were achieved in all patients. The mean number of sessions was 1 (range 1-3). The mean total volume of glue mixture used was 4.0 mL (range 1-13 mL). There was no occurrence of early FV rebleeding, procedure-related complications, or bleeding-related death. The cumulative rebleeding-free rate at 1, 3, and 5 years was 94.5%, 89.3%, and 82.9%, respectively.
Obliteration of bleeding FV with N-butyl-2-cyanoacrylate is safe and effective with use of a standardized injection technique and regimen.
正丁基-2-氰基丙烯酸酯已成功用于治疗胃底静脉曲张（FV）出血。然而，有报道称其再出血率较高，且存在包括栓塞在内的严重并发症。
我们的目的是通过使用标准化注射技术和方案来分析正丁基-2-氰基丙烯酸酯治疗FV出血的安全性和有效性。
回顾性研究。
两家三级转诊中心。
共有131例FV患者（91例男性/40例女性）通过标准化技术和方案接受了正丁基-2-氰基丙烯酸酯闭塞治疗。
（1）用0.8 mL碘油稀释0.5 mL正丁基-2-氰基丙烯酸酯；（2）每次注射将混合物体积限制在1.0 mL以内，以尽量降低栓塞风险；（3）重复进行每次1.0 mL的曲张静脉内注射，直至止血；（4）闭塞FV的所有分支；（5）初始治疗4天后复查内镜，确认所有可见静脉曲张完全闭塞，必要时重复注射正丁基-2-氰基丙烯酸酯以实现完全闭塞。
即时止血率、早期再出血率、出血相关死亡率、手术相关并发症、长期累积无再出血率和累积生存率。
所有患者均实现了初始止血和静脉曲张闭塞。平均疗程数为1次（范围1 - 3次）。所用胶水混合物的平均总体积为4.0 mL（范围1 - 13 mL）。未发生早期FV再出血、手术相关并发症或出血相关死亡。1年、3年和5年的累积无再出血率分别为94.5%、89.3%和82.9%。
使用标准化注射技术和方案，用正丁基-2-氰基丙烯酸酯闭塞出血性FV是安全有效的。
