Cyanoacrylate Therapy for Bleeding Gastric Varices: A Community-Based Case Series and Results of a Survey of U.S. Endoscopists

Introduction: Current GI society guidelines specify cyanoacrylate injection as the preferred treatment for bleeding gastric varices. However, little is known regarding the use of this treatment in routine practice in the U.S. The purposes of this study were: 1) To evaluate the outcomes of cyanoacrylate injection for bleeding gastric varices in a community-based practice, and 2) To conduct a survey of treatment preferences of bleeding gastric varices among U.S. endoscopists. Methods: 1) Retrospective review of patients with bleeding gastric varices in a large U.S. communitybased practice from 2009 to 2014. Among these patients, n-butyl-2 cyanoacrylate injection was the primary method of endoscopic therapy. 2) Online survey of U.S. endoscopists regarding practice patterns of treatment of bleeding gastric varices and factors affecting choice of treatment. Results: Please see tables. Conclusion: Similar to previous studies, this series demonstrated a high success rate and low complication rate among patients treated with cyanoacrylate injection for bleeding gastric varices. Survey data of U.S. endoscopists revealed preferential use of mechanical methods for gastric variceal bleeding; nearly 90% of respondents expressed concerns about technical aspects of cyanoacrylate injection. These data suggest that cyanoacrylate therapy for bleeding gastric varices may be under-utilized by U.S. endoscopists.Table 1: Case Series of Bleeding Gastric Varices Treated With Cyanoacrylate ( N = 20)Table 2: Survey Data of U.S. Endoscopists ( N =443)