Published online Nov 21, 2017. doi: 10.3748/wjg.v23.i43.7746
Peer-review started: July 24, 2017
First decision: August 30, 2017
Revised: September 12, 2017
Accepted: October 28, 2017
Article in press: October 28, 2017
Published online: November 21, 2017
To focus on procedure-related complications, evaluate their incidence, analyze the reasons and discuss the solutions.
Overall, 628 endoscopic gastric variceal obturation (EGVO) procedures (case-times) with NBC were performed in 519 patients in the Department of Endoscopy of the Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to December 2016. The clinical data of patients and procedure-related complications of EGVO were retrospectively analyzed.
In the 628 EGVO procedures, sticking of the needle to the varix occurred in 9 cases (1.43%), including 1 case that used lipiodol-diluted NBC and 8 cases that used undiluted NBC (P = 0.000). The needle was successfully withdrawn in 8 cases. Large spurt bleeding occurred in one case, and hemostasis was achieved by two other injections of undiluted glue. The injection catheter became blocked in 17 cases (2.71%) just during the injection, and 4 cases were complicated with the needle sticking to the varix. Large glue adhesion to the endoscope resulted in difficulty withdrawing the endoscope in 1 case. Bleeding from multiple sites was observed in the esophagus and gastric cardia after the endoscope was withdrawn. Hemostasis was achieved by 1% aethoxysklerol injection and intravenous somatostatin. The ligation device stuck to the varices in two cases during the subsequent endoscopic variceal ligation. In one case, the ligation device was successfully separated from the esophageal varix after all bands were released. In another case, a laceration of the vein and massive bleeding were observed. The bleeding ceased after 1% aethoxysklerol injection.
Although EGVO with tissue glue is usually safe and effective, a series of complications can occur during the procedure that may puzzle endoscopists. There is no standard operating procedure for addressing these complications. The cases described in the current study can provide some reference for others.
Core tip: Tissue glue has been widely used in endoscopic gastric variceal obturation (EGVO) but there is little discussion on procedure-related complications. In our study, the procedure-related complications in 628 EGVO procedures with tissue glue were retrospectively analyzed. These complications include sticking of the needle to the varix, glue adhesion to the endoscope, blockage of the catheter, and sticking of the ligation device to the esophageal varices in the subsequent endoscopic variceal ligation. Although these complications were rare, they may be fatal and always puzzle the endoscopists. Besides incidence, how to tackle and prevent these complications were discussed in the current study.