Published online Nov 27, 2016. doi: 10.4240/wjgs.v8.i11.729
Peer-review started: February 2, 2016
First decision: March 23, 2016
Revised: August 2, 2016
Accepted: September 7, 2016
Article in press: September 8, 2016
Published online: November 27, 2016
Histoacryl glue is used increasingly for the treatment of gastric and ectopic varices, and there is experience in its use for oesophageal varices. It is an effective treatment, yet numerous reports of complications have accumulated. This review of the literature describes the technique, explores circulatory and vascular consideration unique to portal hypertension and categorises the complications into: “Embolisation”, “local venous thrombosis”, “fistulisation and extravascular injection”, “ulceration, erosion and extrusion”, and “nidus of infection”. A case is then made for standardisation of the technique and the consent process.
Core tip: N-butyl-2-cyanoacrylate (Histoacryl “glue”) injection is of proven efficacy for the treatment of bleeding gastric varices but its utility in bleeding oesophageal varices remains unproven. Overall complication rates are 0.5%-5%, 1% being commonly quoted. Complications include pulmonary and systemic arterial embolisation, portal and mesenteric vein thrombosis, persistent sepsis, fistulisation and mucosal erosion due to extravascular injection, and late extrusion or variceal ulceration. Consent processes and injection techniques vary according to local experience, and there is a case for national/international agreement to standardise these.