Endoscopic treatment of gastroesophageal varices in young infants with cyanoacrylate glue: a pilot study

Abstract

Background: In children, endoscopic sclerotherapy and variceal ligation (EVL) are the most used techniques for the treatment of gastroesophageal variceal bleeding (VB). However, these techniques achieve poor results in cases of gastric variceal bleeding, and EVL is not applicable in young infants.

Objective: Our purpose was to evaluate the feasibility, efficacy, and safety of cyanoacrylate glue injection for the treatment of gastroesophageal varices in young infants.

Design: Single-center prospective study.

Patients: From 2001 to 2005, 8 young infants (<or=2 years old, <or=10 kg) with portal hypertension and gastroesophageal varices underwent treatment with N-butyl-2-cyanoacrylate.

Main outcome measurements: Demographic data and the results were registered and analyzed at 1, 6, and 12 months after treatment.

Results: The mean age and weight were 1.3 +/- 0.42 years (range 0.8 to 1.9 years) and 8.5 +/- 1.6 kg (range 5.5 to 10 kg). Glue injection was successfully performed in all infants. The mean volume injected was 1.15 +/- 0.62 mL (range 0.5 to 2 mL). Immediate control of bleeding was achieved in all cases. Ulcer bleeding as a complication was observed in 1 case. Varices relapse with bleeding was observed in 3 of 8 (37.5%) patients after a mean of 12.5 +/- 10.6 weeks (range 5 to 20 weeks). Patients with variceal rebleeding were retreated. Varices eradication was achieved in all cases after a mean of 1.4 +/- 0.52 sessions (range 1 to 2 sessions).

Limitations: Open prospective series with a relatively small number of patients.

Conclusion: In young infants, the use of cyanoacrylate glue is safe and effective for the treatment of gastroesophageal VB.