Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2017; 23(43): 7746-7755
Published online Nov 21, 2017. doi: 10.3748/wjg.v23.i43.7746
Procedure-related complications in gastric variceal obturation with tissue glue
Yun-Wei Guo, Hui-Biao Miao, Zhuo-Fu Wen, Jie-Ying Xuan, Hao-Xiong Zhou
Yun-Wei Guo, Hui-Biao Miao, Zhuo-Fu Wen, Jie-Ying Xuan, Hao-Xiong Zhou, Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Guo YW and Miao HB contributed equally to this work; Guo YW designed the study; Guo YW, Miao HB, Wen ZF, Xuan JY and Zhou HX performed the research; Guo YW and Miao HB analyzed the data and wrote the paper.
Supported by Guangdong Science and Technology Program, No. 2016A020216012.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Third Affiliated Hospital of Sun Yat-Sen University.
Informed consent statement: All study participants, or their legal guardian, provided informed consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun-Wei Guo, MD, PhD, Associate Professor, Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. guoyw@mail.sysu.edu.cn
Telephone: +86-20-85252156 Fax: +86-20-85253336
Received: July 21, 2017
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
Abstract
AIM

To focus on procedure-related complications, evaluate their incidence, analyze the reasons and discuss the solutions.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Endoscopic gastric variceal obturation, Tissue glue, N-butyl-2-cyanoacrylate, Complications

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.