N-butyl-2-cyanoacrylate (Histoacryl) is a watery substance that polymerizes and hardens instantaneously when it comes into contact with blood. This unique property makes it attractive for use in obliterating varices. It is particularly useful in the treatment of fundic varices. Histoacryl is reconstituted with Lipiodol (0.8 mL in 0.5 mL), an oil-based radiopaque contrast agent) the therapeutic channel of the endoscope is first rinsed with 2mL of Lipiodol. The injectionneedle is then filled with 2mL of Lipiodol. The varix is punctured, and the Histoacryl-Lipiodol mixture is injected. Before retraction of the needle, residual glue is pushed into the varix with a further 2mL of Lipiodol. The needle is then retracted, and the catheter is rinsed with water. It is important at this juncture not to activate suction in the endoscope, and to continue irrigation to avoid contact between the glue and the lenses.
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