Efficacy and Safety of N-Butyl 2 Cyanoacrylate Injection for Treatment of Gastric Varices: A five year experience from a tertiary care hospital in Karachi, Pakistan

OBJECTIVES: To evaluate the efficacy and safety of N-Butyl 2 Cyanoacrylate injection for treatment of gastric varices. METHODS: This was a retrospective observational cohort conducted at Medical Unit IV, Department of Gastroenterology, JPMC, Karachi from January 2014 to December 2018 (five years). All patients irrespective of age and gender that presented to the emergency department with complain of hematemesis or stigmata of UGIB were potential candidates. Once they were resuscitated and endoscopic evidence of gastric varices requiring intervention was found, the patients were inducted into the study. N-Butyl 2 Cyanoacrylate injection was performed until hemostasis and obliteration of gastric varices was achieved. Response to therapy was analyzed at three weeks with repeat endoscopy. Mortality was analyzed at six weeks. Major and minor complications recorded as well. RESULTS: A total of 159 patients were inducted into the study. Isolated gastric varices Type-I was mostly encountered. A singular session was sufficient to achieve obliteration and hemostasis in over three quarter of the patients. Complications affected 11.30% of the patients. Six weeks mortality was exceptionally low at 1.20%. CONCLUSIONS: N-Butyl 2 Cyanoacrylate is safe and effective for treatment of gastric varices. There were few complications seen with this procedure in this study. It significantly reduces mortality at six weeks.