Bleeding from gastric varices is a life-threatening complication of portal hypertension, carrying high morbidity and mortality. Endoscopic injection of cyanoacrylate glue is a first-line therapy for isolated gastric varices (IGV1) and gastroesophageal varices (GOV), achieving immediate hemostasis in over 90% of cases in prior studies. We report our 8-year experience from a tertiary hospital in Athens, evaluating the efficacy, safety, and survival outcomes of this treatment. 

We retrospectively analyzed all patients treated with N-butyl cyanoacrylate (Glubran) injection for acute IGV1 or GOV bleeding from 2014 to 2022 in our endoscopy unit. Twenty-six patients (n=26) were identified (77% male; median age 57 years, range 14–86). Underlying etiologies of portal hypertension included cirrhosis (alcoholic or viral), portal vein thrombosis, myeloproliferative disorders, and others. Data on hemostasis success, complications, and survival to hospital discharge were collected. Hemostasis success was defined as control of bleeding without need for additional rescue therapy. Safety assessment focused on procedure-related adverse events. Survival was evaluated as survival to discharge and early outcomes. 

A total of 26 endoscopic glue injection sessions were performed for active gastric variceal hemorrhage (85% IGV1, 15% GOV). Acute bleeding control was achieved in 24 patients (92.3%). Two patients (7.7%) had refractory hemorrhage despite glue injection, requiring emergency intubation and intensive care. No patient required a second endoscopic session, and no procedurerelated complications (such as glue embolization or distant thrombosis) were observed. Twenty-one patients (80.8% of the cohort) survived the acute episode and were discharged alive, yielding an in-hospital mortality of 0% among cases with known outcomes. Three patients (11.5%) had indeterminate immediate outcomes due to transfer or loss to follow-up, but none of these had documented failure of hemostasis at the time of endoscopy. No early rebleeding was noted in the successfully treated patients during their hospital stay. Over the 8-year period, the annual case load ranged from 1 to 6 cases, with a noticeable dip in 2020–2021 (COVID19 pandemic years). There was no clear temporal trend in treatment success or complication rates – outcomes remained consistently high across the study period regardless of year. Notably, the efficacy of glue injection was comparable in both isolated gastric varices and gastroesophageal varices. Overall, our series demonstrated a high hemostasis success rate and favorable short-term survival in this high-risk patient population

Endoscopic cyanoacrylate injection proved to be a highly effective and safe intervention for bleeding IGV1 and GOV varices in our single-center experience. The therapy achieved prompt hemostasis in the vast majority of cases and resulted in excellent survival to discharge, with minimal procedure-related adverse events. These findings support cyanoacrylate glue injection as an indispensable first-line treatment for gastric variceal hemorrhage, offering life-saving hemorrhage control and encouraging outcomes even in a Western tertiary care setting. Our real-world results align with previously reported success rates and underscore the critical role of endoscopic intervention in improving survival for gastric variceal bleeding