Glue Injection

Under endoscopic guidance, a liquid monomer called cyanoacrylate glue is injected via a needle into the varix. After coming into contact with blood, the glue polymerizes and solidifies into a hard substance, plugging up the varix.

Different modalities exist under endoscopic treatment. Sclerotherapy, which is nearly obsolete, involves injection of a sclerosant into a varix. Band ligation has replaced sclerotherapy for the treatment of type 1 GOVs and involves application of a rubber band to a varix in order to strangulate the blood flow. This approach is not recommended for IGVs, as varices in the fundus are larger in size, are located in the submucosa, and have a thick overlying mucosa, making it difficult to suck the entire varix into the band. If the varix and its contralateral wall cannot be captured entirely, blood flow still exists and can result in massive bleeding (ie, hemorrhage).