Abstract
Sclerotherapy with α-cyanoacrylate monomer (CA) was performed on 3 cases of emergent bleeding from intractable isolated gastric varices (Lg) and successful hemostasis was obtained in all cases. A concentration of CA at 40% consisting of 0.4ml CA and 0.6ml Lipiodol was effectively used for 3 cases of the isolated gastric varices untreatable by 5% ethanolamine oleate (EO) sclerotherapy. The CA sclerotherapy seemed to be useful for the varices in the stomach, especially in the fornix, isolated or unconnected to the esophageal varices. One of them also had esophageal varices with no communication with the gastric varices, marking it impossible to treat by regurgitation of EO from the esophageal varices. Esophageal varices disappeared completely in the other 2 cases in which sclerotherapy had done previously. These 2 cases, which had been observed for morbid condition in the state of residual Lg, presented massive bleeding 6 and 52 months later, respectively. Injection of EO into the Lg for hemostasis were tried many times. However, they were failed. Preoperative varicerography with Iopamidol revealed its weak concentration, thick blood vessels and fast blood flow. Then, sclerotherapy with CA was successfully performed with immediate hemostasis. However, in view of CA remaining in situ as foreign body, the indication for the present sclerotherapy should be selected cautiously. Therefore, among cases of acute bleeding from isolated gastric varices, inoperatable or refused to undugo operation and, moreover, EO-ineffective cases are regarded as indicated.
