A modified percutaneous transhepatic varices embolization with 2-octyl cyanoacrylate in the treatment of bleeding esophageal varices.

BACKGROUND

To evaluate the effect of a modified percutaneous transhepatic variceal embolization (PTVE) with 2-octyl cyanoacrylate (2-OCA) on the prevention and treatment of esophageal variceal bleeding.

METHODS

Between March 2002 and December 2005, PTVE was attempted in 92 patients with esophageal varices, 74 patients with recent variceal bleeding, 18 patients with acute variceal bleeding. The 2-OCA was injected into the entire lower esophageal and periesophageal or paraesophageal varices, the cardial submucosal, and perforating vessels.

RESULTS

PTVE was successfully performed in 89 of 92 patients, providing a procedural success rate of 96.7%. According to the distribution of injected 2-OCA, 3 types of variceal embolization were defined, esophagogastric obliteration (n=42), gastric obliteration (n=34), and main left gastric vein obliteration (n=13). Acute variceal bleeding was immediately arrested in all 18 (100%) patients after the procedure. During the median follow-up period of 37 months, the total rebleeding rate was 19.1% (17/89), with the rate being higher in patients with main left gastric vein obliteration 46.1% (6/13) than in patients with esophagogastric obliteration 9.5% (4/42) or with gastric obliteration 20.6% (7/34, P<0.05). Total survival rate was 74.4%, with the rate being significantly higher in patients with esophagogastric obliteration and gastric obliteration than that in patients with left gastric vein obliteration demonstrated by Kaplan-Meier analysis (P<0.001, log-rank test). There was 1 patient with fatal bleeding at the puncture site after the PTVE procedure, and 1 patient with slight pulmonary embolism; there were no other major procedure-related complications.

CONCLUSIONS

The effect of PTVE with 2-OCA on esophageal varices is associated with the site and range of embolization. With the lower esophageal and periesophageal varices and/or the cardial submucosal and perforating vessels are sufficiently obliterated, PTVE with 2-OCA can improve long-term efficacy by preventing varices recurrence and rebleeding.