Background and study aims: Endoscopic tissue glue cyanoacrylate (Histoacryl) injection has become established as an effective, nonsurgical method of treating bleeding gastric varices. However, there are still some controversies concerning technique, complications, and long-term efficacy. In this 17-year study, the efficacy and safety of treatment of gastric variceal bleeding with Histoacryl were clarified and the baseline patient-related prognostic factors were identified.
Patients and Methods: Seventy-one patients with fundal gastric variceal bleeding underwent endoscopic obliteration with Histoacryl diluted with 5% Lipiodol (1:1). The gastric varices and visible supply veins were occluded under fluoroscopic guidance.
Results: The primary successful hemostasis rate was 95.8%. Fifty-five of the patients (77.5%) remained free of variceal bleeding during the entire follow-up period. Complications were generally mild; however, five patients developed accidental complications: one developed splenic infarction, two developed splenic vein thrombosis, and two developed gastric wall necrosis. The median survival time was 5.5 years and the one-year, 10-year, and 15-year cumulative survival rates were 76%, 28%, and 12%, respectively. In the final multivariate baseline model, the Child-Pugh classification was identified as a poor prognostic factor. With regard to blood parameters, the serum total bilirubin level, prothrombin time, and platelet count were significant prognostic factors.
Conclusion: Endoscopic obliteration with Histoacryl was highly effective for the management of fundal gastric variceal bleeding in the short term and the long term. The prognosis of the patients depended on the severity of the underlying liver disease. KEY WORDS: gastric variceal bleeding, cyanoacrylate glue, survival, complications, prognostic factors

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In 2005 we retrospectively analyzed natural history of solitary gastric varices, and revealed that risk factors for hemorrhage from the varices were (1) decompensated hepatic reserve (Child C) (2) history of sclerotherapy of esophageal varices (3) heavy drinkers (4) erosion and positive red color sign on the varices (5) presence of hepatocellular carcinoma. Since we found these risk factors, we defined the indication of therapy for solitary gastric varices as “cases with large varix having erosion or positive red color sign which accompanies one or more above-mentioned risk factors”. We retrospectively compared cases experienced before 2005 and those after 2006, and revealed that setting of the criteria significantly reduced the incidence of hemorrhage.
Our criteria is effectiveand valid for the selection of candidates for prophylactic therapy of solitary gastric varices.

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[in Japanese]

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