Two patients with the diagnosis of liver cirrhosis and portal hypertension related to hepatitis infection were admitted to Shanghai Ruijin hospital due to recurrent melena and hematemesis. Isolated gastric varices were observed in the gastric fundus during the retroflexion of gastroscope. The authors carried out endoscopic sclerotherapy using cyanoacrylate combined with aethoxysklerol for bleeding gastric varices, which disappeared dramatically within six months after two sclerotherapies for each patient. The compound effect of obliteration by α-cyanoacrylate alkyl and eradication by aethoxysklerol was satisfying. No complication and clinical signs of gastrointestinal re-bleeding were observed during six months of endoscopic follow-up. Meanwhile, follow-up of these two patients are still under way.
A report article to be published on 14 June 2008, in the World Journal of Gastroenterology addresses this case. The research team led by Yun-Lin Wu and his colleagues in the Ruijin Hospital Affiliated to Shanghai Jiaotong University carried out endoscopic sclerotherapy successfully using cyanoacrylate combined with aethoxysklerol for bleeding gastric varices, which disappeared dramatically within several months after two sclerotherapies for each patient.
CT portal angiography (CTPA) has come into wider spread of use in the assessment of variceal treatment and in further attempts to improve the results of endoscopic injection therapy. The authors detected the varices and made assessments of portosystemic collaterals through CTPA before sclerotherapy. After the injection of adhesives combined with sclerosants, CTPA revealed the vessels blocked by adhesive polymer, the obliteration and elimination of gastric varices, which were believed as a convincing sign of effective treatment.
Although the optimal treatment for gastric fundal variceal bleeding still remains controversial, the novel sclerotherapy using alpha -cyanoacrylate alkyl combined with aethoxysklerol coule be an alternative and feasible method for obliteration and eradication of gastric fundal varices.