Endoscopic Cyanoacrylate Injection: Less Oil for Less Ectopic Embolism C.Z. Li 1 , L.F. Cheng 1 , Z.Q. Wang 1 , F.C. Cai 1 , Q.Y. Huang 1 , E.Q. Linghu 1 1 General Hospital of Chinese PLA Background and Aim: Endoscopic injection sclerotherapy with N-butyl-2cyanoacrylate (NBCA, histoacryl) has been reported to be effective for hemostasis of bleeding gastric varices, but occasionally the gel flows to other organs and causes ectopic embolism. The present study aimed to determine whether less amount of iodized oil preload in NBCA injection helps in decreasing ectopic embolism. Methods: From January 1997 to April 2006, 2 different methods of endoscopic NBCA injection, "Sandwich method" and "modified Sandwich method" (in which iodized oil preload was minimized), were applied on 635 GV cases, to evaluate if decrease of iodized oil preload resulted in less ectopic embolism. Results: Altogether 5 cases of ectopic embolism occurred in the whole group (0.8%), including 3 cases of splenic infarction, 1 case of transient paralysis and 1 case of minor infarction of the lung. The modified Sandwich method showed some superiority over original method in decreasing ectopic embolism (0/276 vs. 5/359, p=0.049). Less cough during procedure was also found with the modified method (3/276 vs. 18/359, p=0.006). Conclusions: Less amount of iodized oil preload in endoscopic NBCA injection is beneficial to decrease ectopic embolism. Background: Portal hypertension is closely associated with serious complications of liver cirrhosis which contribute to bad prognosis. Hepatocellular carcinoma (HCC) and low serum sodium (SNa) are manifestations of end-stage liver disease (ESLD) and are associated with poor survival in decompensated cirrhosis patients. Therefore, we aimed to determine the relationship between hepatic venous pressure gradient (HVPG) and the development of HCC or low SNa in decompensated alcoholic cirrhosis patients. Methods: Child-Pugh scores, MELD scores, and HVPG at baseline, and the development of low SNa (SNa <130 mEq/L) or HCC during follow-up were analyzed prospectively in 170 patients with decompensated alcoholic liver cirrhosis. The predictive values of different risk factors for the progression to the ESLD were investigated by multivariate analysis and the Kaplan-Meier method Results: Twenty-four patients developed HCC during the follow-up period. In the multivariate analysis, only baseline HVPG>15mmHg was an independent predictive factor for the development of HCC (relative risk (RR)=1.128, P<0.05). Those with HVPG >15 mmHg showed a significantly shorter time for the development of HCC on Kaplan-Meier analysis. Twenty patients developed low SNa during follow-up. Initial HVPG was also an independent predictive value for the development of low SNa in the multivariate analysis (RR=1.169, P<0.05). Those with HVPG>15 mmHg also showed significantly shorter times for the development of low SNa on Kaplan-Meier analysis. Conclusions: In decompensated alcoholic cirrhosis, HVPG may be a useful predictive factor for the development of HCC and low SNa, both of which are characteristic of ESLD and poor prognosis.