Endoscopy Plus Glue injection

Endoscopy allows doctors to see inside the digestive tract, while glue injection is the therapeutic part of the procedure. During glue injection, a liquid adhesive is delivered through the endoscope into the varices. The glue rapidly hardens, sealing the vein and preventing further bleeding.

The most commonly used material is N-butyl-2-cyanoacrylate, which is safe for internal medical use and has been proven highly effective in stopping gastric variceal bleeding.

Why is the Procedure Needed?

Gastric varices occur in about 20–30% of patients with portal hypertension and are more prone to severe, massive bleeding compared to esophageal varices.

Endoscopy plus glue injection is recommended for:

• Active bleeding gastric varices (emergency treatment).
• Prevention of re-bleeding in patients at high risk.
• Cases where band ligation is ineffective due to varix size or location.
• Patients with portal hypertension who have had previous bleeding episodes.

Preparation for Endoscopy Plus Glue Injection

Before the procedure, patients are carefully prepared:

• Hospital admission – Most patients present with active bleeding and are already admitted.
• Stabilization – Blood transfusions or IV fluids may be given to manage shock.
• Fasting – No food or drink for 6–8 hours prior to the procedure.
• Medication adjustments – Blood-thinning medicines may be stopped.
• Informed consent – The patient or family is briefed about the procedure, benefits, and risks.

How the Procedure is Performed

The process usually takes 20–40 minutes, depending on the severity:

• Sedation – The patient is sedated and monitored throughout.
• Endoscopic visualization – The endoscope is passed through the mouth into the stomach.
• Identification of varices – The gastroenterologist locates the bleeding or high-risk veins.
• Glue injection – A fine needle is inserted through the endoscope, and cyanoacrylate glue is injected directly into the varix.
• Effect – The glue hardens instantly, blocking the vein and stopping the bleed.

Benefits of Endoscopy Plus Glue Injection

• Highly effective for gastric varices compared to banding or sclerotherapy
• Rapid control of bleeding in emergency situations
• Minimally invasive with no need for surgery
• Prevents recurrence of bleeding in many patients
• Improves survival rates in high-risk cirrhotic patients

Risks and Complications

While generally safe in experienced hands, some complications may occur:

• Fever and pain at the injection site
• Ulcer formation where glue is injected
• Re-bleeding if the varix reopens
• Rarely, embolization, where glue migrates to other organs like the lungs or kidneys
• Infection (very rare)

Aftercare and Recovery

Post-procedure care is critical for patient recovery:

• Monitoring – Patients are observed for 24–48 hours in hospital.
• Diet – Soft or liquid diet initially to avoid irritation.
• Medications – Proton pump inhibitors (PPIs) to reduce acid, beta-blockers to lower portal pressure.
• Follow-up endoscopy – Repeat sessions may be needed to treat remaining or new varices.
• Liver care – Managing cirrhosis and underlying portal hypertension is essential for long-term success.

Comparison with Other Treatments

• Band ligation – Effective for esophageal varices but less useful for gastric varices.
• Sclerotherapy – Less effective and associated with higher complication rates compared to glue.
• TIPS procedure (Transjugular Intrahepatic Portosystemic Shunt) – Often used when bleeding cannot be controlled by endoscopy.
• Medications – Non-selective beta-blockers help prevent recurrence but are not sufficient alone.

Glue injection remains the first-line endoscopic therapy for gastric varices.

Long-Term Outlook

Patients who undergo endoscopy plus glue injection often experience significant improvement, but close follow-up is essential. Gastric varices may recur, so repeat injections or alternative treatments like TIPS may be required.

Since the root cause is usually chronic liver disease, patients must continue liver health management, including abstaining from alcohol, treating hepatitis, and regular check-ups with a gastroenterologist.