Novel predictors for immediate puncture site bleed during endoscopic glue injection for gastric varices without using lipiodol

Endoscopic obturation of gastric varices using tissue adhesive glues like cyanoacrylate is an accepted modality for the treatment of gastric varices. This study was undertaken to determine whether it was possible to predict immediate puncture site bleed on withdrawal of needle catheter during endoscopic glue injection without lipiodol. We prospectively analyzed 100 consecutive patients with cirrhosis who underwent glue injection. Glue injection was successful in all the patients. Immediate puncture site bleed was observed in only four cases and all of them correlated with negative catheter pull sign and positive red catheter sign. Catheter pull sign and red catheter sign were excellent predictors of immediate puncture site bleed during endoscopic glue injection and should be routinely tested.