Blutende gastrale und duodenale Varizen: endoskopische Embolisation mit Gewebekleber

Abstract

Endoscopically guided intravascular injections of the tissue glue N-butyl-2-cyanoacrylate have since 1990 been performed in eight patients (seven men, one woman; median age 59.5 [40-72] years) with cirrhosis of the liver (alcoholic: n = 6, posthepatic, n = 2), decreased haemoglobin (6-10 g/dl) and transient shock symptoms (n = 5) due to gastric (n = 7) or duodenal varices (n = 1). Gastric acid production was suppressed with omeprazole. Neither balloon catheters nor drugs were used to lower portal vein pressure. Initial haemostasis was achieved in all patients. One patient with consumption coagulopathy died of recurrent bleeding from varices in the body of the stomach which could be only temporarily arrested. Another patient had a recurrence of bleeding from varices in the cardia 3 months after the initial treatment: it was again controlled by endoscopic sclerotherapy with tissue glue. All other patients remain free of bleeding after a mean observation time of 8.4 months.