Correlation between glue cast extrusion and re-bleeding after endoscopic gastric varices obturation using tissue adhesive

Objective To investigate the correlation between glue cast extrusion and re-bleeding after endoscopic gastric varices obturation using tissue adhesive. Methods The inpatients of Department of Gastroenterology, Shanghai Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine during January 2010 and July 2017 were reviewed.All the patients received endoscopic gastric varices obturation using tissue adhesive and were followed-up by endoscopy for at least 12 months.The medical history, endoscopic features, treatment and follow-up results were studied. Results A total of 55 patients received endoscopic gastric varices obturation(33 male, 22 female, average age(60.0±14.6)years old), with 12 cases of type GOV1(21.8%), 11 cases of GOV2(20.0%)and 32 cases of IGV1(58.2%). Fifty-eight endoscopic procedures were performed on 64 sites, with an average dose of(3.79±1.55)ml of 1% polidocanol and(3.02±1.17)ml of tissue adhesive per injection site.All patients survived in the 1-year follow-up period among which 11 re-bleeding sessions in 10 patients(IGV1 in 7 patients and GOV2 in 3)were observed.The cause of re-bleeding included 8 cases of glue cast extrusion ulceration, 2 cases of new gastric varices and a case of angular ulcer of the stomach.The average period for healing of glue extrusion ulcer was(8.3±3.4)months, with the healing process completed within 4-9 months in 36 patients(69.2%). Follow-up was extended to 2 years in 9 patients with a glue cast extrusion process≥12 months, during which extrusion was completed in all patients without re-bleeding. Conclusion Endoscopic gastric varices obturation using tissue adhesive is an important secondary prevention method for gastric varices bleeding.Glue cast extrusion is a normal phenomenon after endoscopic gastric varices obturation.Re-bleeding could be associated with inadequate obturation of the gastric varices.It could be helpful to ensure complete obturation of the gastric varices in order to reduce the risk of re-bleeding. Key words: Gastric varices; Endoscopy; Bleeding; Tissue adhesive; Glue cast extrusion