Procedure-related complications in gastric variceal obturation with tissue glue

Figure 1 Sticking of the needle to the varix in three patients. A-C: Large GOV2 varices were obturated with tissue glue. The needle stuck to the varix and was successfully withdrawn without bleeding. The varices exhibited full solidification; D-F: A GOV1 varix with a post-bleeding break was obturated with tissue adhesive. The needle stuck to the varix and was successfully withdrawn, leaving little errhysis; G-I: A GOV1 varix with post-bleeding erosion was obturated with tissue glue and was successfully withdrawn without bleeding. The varix was soft, and another injection was performed. GOV: Gastroesophageal varices.

Figure 2 Sticking of the needle to the varix in one patient. A: A mass of GOV2 varices in one patient with HBV cirrhosis; B: Blockage of the catheter and sticking of the needle occurred at the same time when the tissue glue was being injected; C: Laceration of the varix and large spurt bleeding occurred; D and E: An injection with 3 mL of undiluted tissue glue was performed, and dropwise bleeding was observed; F and G: Another injection with 1 mL of undiluted tissue glue was performed, and hemostasis was achieved; H: A repeat endoscopy 6 mo later shows that the GOV2 varices were dramatically alleviated. Extrusion of the glue and some hyperplasia of the local gastric mucosa were observed. GOV: Gastroesophageal varices.

Figure 3 Glue adhesion to the endoscope in one patient. A and B: Three GOV1 varices were observed; C: Obturation of one varix with tissue glue; D: The glue leaked out but the reversed endoscope blocked the vision; E: A large mass of solidified glue adhered to the endoscope and damaged the cardia; F: The glue was 1.5 cm in width and 3.0 cm in length; G and H: A large area of mucous was damaged in the esophagus and gastric cardia. Bleeding was observed, especially a gush of blood at the cardia; I: The bleeding at the cardia ceased after a 1% aethoxysklerol injection; J-L: The patient underwent follow-up 5 wk later. Extrusion of the glue from the gastric varices was observed, and EVL was performed to eradicate the esophageal varices. GOV: Gastroesophageal varices; EVL: Endoscopic variceal ligation.