Gastric Varices - Endoscopic Ablation With Cyanoacrylate Glue (12 of 18)

Successful obliteration with hardening of variceal bed. A follow up endoscopy one week later was performed. It is essential to define the endpoint of treatment, as well as have a standardized protocol to achieve the endpoint. The goal of cyanoacrylate injection should be the obliteration of visible varices. The term “obliteration” more accurately describes the desired endpoint than “eradication,” because a varix occluded with cyanoacrylate may remain visible for many weeks. The completeness of obliterationdeserves special emphasis, as cyanoacrylates induce mucosal necrosis at the site of injection. The amount of Histoacryl required to achieve obliteration will vary depending on varix size and extent. In general, Histoacryl is injected in aliquots of 0.5 mL (content of 1 ampoule), which translates to 1 to 2 mL after dilution with Lipiodol. Obliteration is tested by palpating the varix with the needle retracted. If “soft,” the varix is injected with an additional aliquot of Histoacryl.