Ruptured esophagogastric variceal bleeding is one of the most serious complications of decompensated cirrhosis, with a mortality rate of 50-70% for the first bleeding and up to 80% for recurrent bleeding, seriously endangering patients’ lives. It is crucial to take active measures to stop and prevent bleeding to prolong the survival of patients. Esophageal varices can be treated by gastroscopic sclerosis and ligation. Gastric fundic variceal bleeding is more dangerous than esophageal variceal bleeding. Due to the special location of fundic veins and the existence of multiple traffic branches with adjacent organs, endoscopic variceal ligation and sclerotherapy are ineffective for fundic variceal bleeding, and patients have a high mortality rate due to repeated bleeding. Surgical shunt or dissection surgery has some effect though. However, due to the poor liver function and general condition of cirrhotic patients, the surgery is risky. The mortality rate is also very high. So, is there any treatment method that is less invasive and more effective? The answer is yes. The endoscopic tissue adhesive variceal intravenous injection has been developed in recent years. It has good efficacy in treating variceal bleeding in the fundus of the stomach. Tissue binder is a water-like curing agent that polymerizes and cures after a few seconds of contact with blood. It can be injected endoscopically into varicose veins to effectively occlude the vessels and control variceal bleeding. Tissue binders are safe for the treatment of fundic varices, with occasional ectopic embolism, and the current sandwich method of endovenous injection of super-liquefied iodine oil with tissue binder and super-liquefied iodine oil into varicose veins helps to reduce embolic complications. For multiple varicose veins, 2-3 points can be injected. After injection, the vein thickens and stiffens, and in some patients, the ruptured vein is seen to be occluded by the emergence of a tissue adhesive that gradually solidifies and turns white. The postoperative management consists of routine fasting and medication, and hospitalization for observation to prevent complications such as bleeding and infection due to tissue glue drainage. In patients treated with this method, the drainage of glue starts after 1 month and the varicose veins of the fundus basically disappear or largely disappear.
The hemostasis and rebleeding should be observed 1 to 24 months after treatment, and the tissue adhesive glue drainage and the disappearance of varicose veins should be reviewed twice after 1 month by gastroscopy.