An Unusual Complication of Endoscopic Cyanoacrylate Injection for Gastric Varix

Question: A 46-year-old man with Child A alcoholic cirrhosis had received band ligation 2 months ago for bleeding esophageal varices. An interval computed tomography scan demonstrated liver cirrhosis with multiple portosystemic collateral circulations and shunts including a large splenorenal shunt (Figure A). In this episode, he presented with melenic stool with anemic symptoms for 2 days. The initial evaluation revealed blood pressure of 92/50 mm Hg with hemoglobin level of only 6.6 g/dL. After resuscitation, an emergency endoscopic evaluation under conscious sedation demonstrated a large gastric varix type 2 (GOV2) with two white nipple signs (Figure B). Thus, endoscopic hemostasis by glue injection was performed using a mixture of 3.0-mL N-butyl-cyanoacrylate and 4.8-mL lipiodol (6 U). An immediate glue cast completely obliterated GOV2 (Figure C). During endoscope withdrawal, the patient developed tachypnea and severe oxygen desaturation followed by a pulseless cardiac arrest. CME Exam 1: An Unusual Complication of Endoscopic Cyanoacrylate Injection for Gastric VarixGastroenterologyVol. 163Issue 5Preview Full-Text PDF