Safety and Cost-Effectiveness of N-butyl-2-Cyanoacrylate without Lipiodol in Endoscopic Management of Gastric Varices

  • Mahmood Ahmad Gujranwala Medical College
  • Muhammad Ayub Gujranwala Medical College/DHQ Teaching Hospital Gujranwala
  • Fawad Iqbal Janjua Gujranwala Medical College/DHQ Teaching Hospital Gujranwala
  • Aisha Majeed
  • Nooman Gilani Gujranwala Medical College/DHQ Teaching Hospital Gujranwala
Keywords: Cirrhosis, Gastric Varices, N-butyl-2-Cyanoacrylate, Outcome

Abstract

Introduction: Gastric varices are frequently seen in patients with portal hypertension. The mainstay of treatment is variceal injection with a mixture of N-butyl-2-Cyanoacrylate and lipiodol. The use of N-butyl-2-Cyanoacrylate without lipiodol is not extensively studied and it can be a cost-effective approach. The objective of our study was to evaluate whether the use of N-butyl-2-Cyanoacrylate without lipiodol is a safe and effective endoscopic treatment for gastric varices.
Material and Methods: This prospective observational study was conducted between June 2016 and May 2017 at the Department of Gastroenterology, Gujranwala Medical College/ DHQ Teaching Hospital, Gujranwala. A total of 100 patients with gastric varices diagnosed on upper GI endoscopy were enrolled in the study. N-butyl-2-Cyanoacrylate without lipiodol was injected into the gastric varices of all the patients. All procedures were performed by experienced gastroenterologists. The patients underwent monthly follow-up endoscopies to determine the outcome and adverse events.
Results: Out of 100 patients, 40 patients (40 %) were men and 60 (60%) were women. The mean age was 53 years. The mean volume of N-butyl-2-Cyanoacrylate used per session was 1.5ml ± 0.5 ml (range 1-2ml). Obliteration of Gastric varices was achieved in 92 patients (92%) while in 04 patients (4%) varices did not obliterate over a mean follow-up of 12 months. No treatment-related immediate or late complications were observed in all patients. Four patients (4%) died of delayed rebleeding (after two weeks of intervention).
Conclusion: Injection therapy of gastric varices with N-butyl-2-Cyanoacrylate alone without lipiodol is a safe and cost-effective method for gastric varices.

Author Biographies

Muhammad Ayub, Gujranwala Medical College/DHQ Teaching Hospital Gujranwala

Assistant Professor Gastroenterology Gujranwala Medical College/DHQ Teaching Hospital Gujranwala

Fawad Iqbal Janjua, Gujranwala Medical College/DHQ Teaching Hospital Gujranwala

Assistant Professor Gastroenterology, Gujranwala Medical College/DHQ Teaching Hospital Gujranwal, Pakistan

Nooman Gilani, Gujranwala Medical College/DHQ Teaching Hospital Gujranwala

Professor of Gastroenterology, Gujranwala Medical College/DHQ Teaching Hospital Gujranwala

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Published
2020-12-30
How to Cite
1.
Ahmad M, Ayub M, Janjua F, Majeed A, Gilani N. Safety and Cost-Effectiveness of N-butyl-2-Cyanoacrylate without Lipiodol in Endoscopic Management of Gastric Varices. JRMC [Internet]. 30Dec.2020 [cited 25Sep.2021];24(4):292-5. Available from: https://journalrmc.com/index.php/JRMC/article/view/1049