Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2016; 8(11): 729-734
Published online Nov 27, 2016. doi: 10.4240/wjgs.v8.i11.729
Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review
Lulia Al-Hillawi, Terence Wong, Giovanni Tritto, Philip A Berry
Lulia Al-Hillawi, Terence Wong, Giovanni Tritto, Philip A Berry, Department of Gastroenterology and Hepatology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: None.
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:
Correspondence to: Dr. Philip A Berry, Department of Gastroenterology and Hepatology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
Telephone: +44-020-71887188 Fax: +44-020-71882484
Received: January 26, 2016
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.

Keywords: Complications, Embolisation, Thrombosis, Sepsis

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.