Endoscopic treatment of gastric varices using N-butyl- 2-cyanoacrylate glue: experience from Ethiopia, sub- Saharan Africa

Abstract

Abstract Background Gastro-esophageal varices (GV) are the major clinical manifestations of cirrhotic and non-cirrhotic portal hypertension. Although less frequent than esophageal varices (EV), They pose a significant clinical challenge due to their propensity for severe bleeding, associated with high morbidity and mortality rates. Endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) has emerged as a promising treatment modality for GV, offering effective hemostasis and low rebleeding rates. This study aims to investigate the practice and outcomes of NBCA injection therapy for gastric varices in Ethiopia. Methods A cross sectional study was conducted on patients who received NBCA injection treatment at Adera Medical and Surgical (AMS) Center from December 2022 to January 2024.Data regarding socio-demographics, clinical characteristics, indications, endoscopic findings, procedure details, complication and outcome were collected from patients’ medical records and through a phone call interview using structured checklist. The acquired data was examined for accuracy, cleaned up and validated before analysis using SPSS 26.0. Descriptive statistics were employed as a statistical data analysis technique for categorical variables, and the results were expressed as frequencies and percentages. Tables and figures were utilized to provide a concise summary of the findings. Categorical data were presented as frequencies, while continuous variables were expressed as means, standard deviations, and minimum and maximum values. Results: The study investigated the use of NBCA injection for treating gastric varices in 49 patients. The mean [± SD] age was 39.92 ± 16.05 years with M: F of 2.5 respectively. IGV1 was the commonest GV type (46.9%). Thirty-Five (71.4%) patients had active bleeding and received NBCA within 12 hours, while the rest received it prophylactically for large varices. Initial bleeding control was achieved in all patients. One patient with active bleeding experienced re-bleeding 25 hours post NBCA glue injection but stopped spontaneously. No procedure-related complications, bleeding, organ embolism, or death were reported. Conclusion: NBCA glue injection demonstrably achieved effective bleeding control in all patients with gastric varices in this study. These findings offer valuable insights for optimizing gastric varices management and reducing the burden of upper gastrointestinal bleeding in Ethiopia, Sub-Saharan Africa. To ensure successful implementation, enhancing healthcare providers' expertise in interventional endoscopic techniques, including NBCA glue injection, is crucial. Further wider research is recommended to explore long-term outcomes and compare the efficacy of NBCA glue injection with other treatment options for gastric varices in Ethiopia and sub Saharan Africa at large.