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Ozaka S, Gotoh Y, Honda S, Iwao T, Kawahara Y, Kinoshita K, Nakaya T, Noguchi C, Kagawa K, Murakami K. Rectal varix treated with endoscopic cyanoacrylate injection therapy. Clin J Gastroenterol 2021; 14:791-795. [PMID: 33389695 DOI: 10.1007/s12328-020-01305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
There is no established treatment for rectal varices. Although endoscopic cyanoacrylate (N-butyl 2-cyanoacrylate) injection therapy is the standard treatment for gastric varices, there are few reports of its use for rectal varices. We present a case of rectal varix that was successfully treated with endoscopic cyanoacrylate injection therapy. An 80-year-old man with cirrhosis was treated for rectal varices with interventional radiology 2 years earlier. At his current presentation, he underwent colonoscopy for hematochezia and anemia, which showed recurrence of rectal varix. We performed endoscopic cyanoacrylate injection therapy for the lesion. However, since we observed bleeding from the treated varix the next day, additional cyanoacrylate was injected. Thereafter, there was no re-bleeding and no recurrence was observed at the 3-year follow-up. According to the previous reports, interventional radiology (IVR), endoscopic sclerotherapy (EIS), and endoscopic variceal ligation (EVL) have been mainly used to treat rectal varices; however, there are few reports of endoscopic cyanoacrylate injection therapy. Our case suggests that endoscopic cyanoacrylate injection therapy might be a useful and safe treatment option for rectal varices.
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Affiliation(s)
- Sotaro Ozaka
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan. .,Department of Gastroenterology, Shin Beppu Hospital, 3898 Tsurumi, Beppu, Oita, 874-8538, Japan.
| | - Yasuhiko Gotoh
- Department of Gastroenterology, Shin Beppu Hospital, 3898 Tsurumi, Beppu, Oita, 874-8538, Japan
| | - Shunichiro Honda
- Department of Gastroenterology, Oita Medical Center, 11 Yokota, Oita, Oita, 870-0263, Japan
| | - Toshiaki Iwao
- Department of Gastroenterology, Takada Central Hospital, 1176-1 Shinchi, Bungotakada, Oita, 879-0627, Japan
| | - Yoshinari Kawahara
- Department of Gastroenterology, Shin Beppu Hospital, 3898 Tsurumi, Beppu, Oita, 874-8538, Japan
| | - Keisuke Kinoshita
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomohisa Nakaya
- Department of Gastroenterology, Shin Beppu Hospital, 3898 Tsurumi, Beppu, Oita, 874-8538, Japan
| | - Chishio Noguchi
- Department of Gastroenterology, Shin Beppu Hospital, 3898 Tsurumi, Beppu, Oita, 874-8538, Japan
| | - Koichi Kagawa
- Department of Gastroenterology, Shin Beppu Hospital, 3898 Tsurumi, Beppu, Oita, 874-8538, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
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Post-Treatment Ulceration and Bleeding After Cyanoacrylate Injection of Duodenal Varices. ACG Case Rep J 2020; 7:e00342. [PMID: 32337308 PMCID: PMC7162136 DOI: 10.14309/crj.0000000000000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/08/2020] [Indexed: 11/26/2022] Open
Abstract
We report a case of recurrent gastrointestinal bleeding in the setting of diffuse duodenal and colorectal varices. These varices were secondary to either congenital absence of the portal vein or chronic occlusion of the portal vein leading to cavernous transformation of a collateral network of varices. He was acutely managed with injection of N-butyl-2-cyanoacrylate into a large complex of duodenal varices. His hospital course was complicated by a postprocedural gastrointestinal bleed within the first 24 hours after the procedure arising from a new duodenal ulcer at the site of injection, likely secondary to ischemia after obliteration of the varices.
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Chawla RK, Madan A, Chawla A. Endo-bronchial application of glue in the management of hemoptysis. Indian J Tuberc 2019; 66:370-374. [PMID: 31439182 DOI: 10.1016/j.ijtb.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hemoptysis from varied etiologies, often fails to respond to conservative therapy. The conventional managements of such a situation are Bronchial Artery Embolization (BAE) or thoracic surgery which is often not possible. Endoscopic application of glue may stand as a method of therapy in these circumstances. METHODS 202 patients of hemoptysis were treated by video-bronchoscopy assisted endobronchial application of glue (n-butyl cyanoacrylate) with the help of polyethylene catheter being placed through the working channel. The details of the procedure and their 6 month follow up are presented. RESULTS Immediate control of hemoptysis was achieved in 183 i.e. 90.59% of patients. 19 patients had a partial response, i.e., hemoptysis stopped and then recurred, endobronchial application of glue was repeated in them out of which 14 (6.9%) responded to the second procedure whereas 5 (2.47%) failed to show any response in spite of the repeated procedure. The complication rate was 0.49% in the form of glue migrating into the trachea. There was no mortality. CONCLUSION Endobronchial application of glue for hemoptysis can be an effective, economic and alternative therapy for mild to moderate hemoptysis.
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Affiliation(s)
- Rakesh K Chawla
- Department of Pulmonary Medicine, Critical Care & Sleep Disorders at Saroj Superspeciality Hospital and Jaipur Golden Hospital, India.
| | - Arun Madan
- Department of Pulmonary Medicine, NDMC Medical College, Civil Lines, Delhi, India
| | - Aditya Chawla
- Department of Pulmonary Medicine, Critical Care & Sleep Disorders at Saroj Superspeciality Hospital and Jaipur Golden Hospital, India
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Use of cyanoacrylate adhesives in general surgery. Surg Today 2014; 45:939-56. [DOI: 10.1007/s00595-014-1056-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/03/2014] [Indexed: 12/16/2022]
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Abstract
Although often considered together, gastric and ectopic varices represent complications of a heterogeneous group of underlying diseases. Commonly, these are known to arise in patients with cirrhosis secondary to portal hypertension; however, they also arise in patients with noncirrhotic portal hypertension, most often secondary to venous thrombosis of the portal venous system. One of the key initial assessments is to define the underlying condition leading to the formation of these portal-collateral pathways to guide management. In the authors' experience, these patients can be grouped into distinct although sometimes overlapping conditions, which can provide a helpful conceptual basis of management.
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Affiliation(s)
- Zachary Henry
- Division of Gastroenterology and Hepatology, University of Virginia Health System, PO Box 800708, Charlottesville, VA 22908-0708, USA
| | - Dushant Uppal
- Division of Gastroenterology and Hepatology, University of Virginia Health System, PO Box 800708, Charlottesville, VA 22908-0708, USA
| | - Wael Saad
- Division of Vascular and Interventional Radiology, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA
| | - Stephen Caldwell
- Division of Gastroenterology and Hepatology, University of Virginia Health System, PO Box 800708, Charlottesville, VA 22908-0708, USA.
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Successful treatment of endoscopically unmanageable rectal varices by balloon-occluded antegrade transvenous sclerotherapy followed by microcoil embolization. J Vasc Interv Radiol 2013; 24:1399-403. [PMID: 23973026 DOI: 10.1016/j.jvir.2013.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/23/2022] Open
Abstract
The present report describes two cases of endoscopically unmanageable rectal varices that were treated by balloon-occluded antegrade transvenous sclerotherapy (BATS) followed by microcoil embolization. Follow-up endoscopy confirmed eradication of the rectal varices. Balloon-occluded rectal venography showed stasis of contrast material and sclerosing agent for 30 minutes in both cases of rectal varices, which indicated that the inflow vessel was a single dilated superior rectal vein without other minor inflow vessels. BATS appears to be a feasible therapeutic option for the treatment of rectal varices of this hemodynamic type.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology, Apollo Gleneagles Hospital, Kolkata, India
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Khaliq A, Dutta U, Kochhar R, Chalapathi A, Singh K. Massive lower gastrointestinal bleed due to rectal varix. Intern Emerg Med 2012; 7 Suppl 1:S57-9. [PMID: 22033787 DOI: 10.1007/s11739-011-0685-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 07/22/2011] [Indexed: 12/31/2022]
Affiliation(s)
- Abdul Khaliq
- Department of Gastroenterology, PGIMER, Sector-12, Chandigarh, India.
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Abstract
Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.
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Almadi MA, Almessabi A, Wong P, Ghali PM, Barkun A. Ectopic varices. Gastrointest Endosc 2011; 74:380-8. [PMID: 21612777 DOI: 10.1016/j.gie.2011.03.1177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 03/14/2011] [Indexed: 12/13/2022]
Affiliation(s)
- Majid Abdulrahman Almadi
- Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, Canada
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Sharma M, Somasundaram A. Massive lower GI bleed from an endoscopically inevident rectal varices: diagnosis and management by EUS (with videos). Gastrointest Endosc 2010; 72:1106-8. [PMID: 20579995 DOI: 10.1016/j.gie.2010.02.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 02/26/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Pincode: 250 001, Uttar Pradesh, India
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Abstract
Ectopic varices (EcV) comprise large portosystemic venous collaterals located anywhere other than the gastro-oesophageal region. No large series or randomized-controlled trials address this subject, and therefore its management is based on available expertise and facilities, and may require a multidisciplinary team approach. EcV are common findings during endoscopy in portal hypertensive patients and their bleeding accounts for only 1–5% of all variceal bleeding. EcV develop secondary to portal hypertension (PHT), surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial in origin. Bleeding EcV may present with anaemia, shock, haematemesis, melaena or haematochezia and should be considered in patients with PHT and gastrointestinal bleeding or anaemia of obscure origin. EcV may be discovered during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, colour Doppler-flow imaging, laparotomy, laparoscopy and occasionally during autopsy. Patients with suspected EcV bleeding need immediate assessment, resuscitation, haemodynamic stabilization and referral to specialist centres. Management of EcV involves medical, endoscopic, interventional radiological and surgical modalities depending on patients’ condition, site of varices, available expertise and patients’ subsequent management plan.
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Park WG, Yeh RW, Triadafilopoulos G. Injection therapies for variceal bleeding disorders of the GI tract. Gastrointest Endosc 2008; 67:313-23. [PMID: 18226695 DOI: 10.1016/j.gie.2007.09.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 09/27/2007] [Indexed: 02/07/2023]
Affiliation(s)
- Walter G Park
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305, USA.
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Barillari P, Basso L, Larcinese A, Gozzo P, Indinnimeo M. Cyanoacrylate glue in the treatment of ano-rectal fistulas. Int J Colorectal Dis 2006; 21:791-4. [PMID: 16625375 DOI: 10.1007/s00384-006-0090-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The management of anal fistula is debatable. Although several procedures have been described, none of them is free from complications, such as anal incontinence and anal pain. The purpose of this study was to evaluate the employment of a glue composed of N-butil-2-cyanoacrylate and methacryloxysulfolane (Glubran 2) to treat fistula-in-ano. PATIENTS AND METHODS Twenty-one patients (14 men and 7 women) with cryptoglandular anal fistula were enrolled in the study and treated as day-cases. Fistulas were assessed both clinically and by trans-rectal endosonography with a rotating 10-MHz 360 degrees endoscopic probe. Assessment of continence was also performed. The fistula tract was identified, curetted and washed-out with normal saline and hydrogen peroxide; then the glue was injected from the syringe nozzle through a catheter previously inserted into the fistula. Additional treatments were performed when the first failed. RESULTS Five of seven simple fistulas (71.4%) healed with primary glue treatment; the other two needed second and third injections, and both healed. Ten of 14 (71.4%) complex fistulas healed with primary treatment; of the other four patients, one showed signs of intolerance to cyanoacrylate, which required re-intervention to remove the applied glue. In the second patient, treatment was successful after a second session; in the third case, three glue injections were required; while the fourth patient was lost at follow-up after three unsuccessful sessions. The ratio of cumulative healing with only one treatment was 15/21 (71.4%), and the ratio of overall healing after more than one session was 19/21 (90.2%). There was no sign of recurrence of the disease after 18 months of follow-up. CONCLUSION Cyanoacrylate glue seems to be ideal to treat fistula-in-ano, as it is a safe, cost-effective, repeatable and muscle-sparing technique. The incidence of recurrence is low, and post-procedure complicated fistulas or perianal abscesses were not reported.
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Affiliation(s)
- Paolo Barillari
- Department of Surgery "Pietro Valdoni", University of Rome "La Sapienza" Medical School, Policlinico "Umberto I", viale del Policlinico 155, 00161 Rome, Italy.
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