Toronto Files - How to Glue gastric varix

Glue
Glubran2 used at SMH

0.5 ml cyanoacryl glue in each ampule. Lipidol comes in 10 ml glass ampules.

- Need heaps of 5 ml and 10 ml syringes, and 23 G 5mm needles

Steps for drawing up glue
1) In a 5 ml syringe, first draw 0.5 ml of lipidol, followed by 0.5 ml of glue
2) In a 10 ml syringe, draw 10 ml of distilled water (not normal saline, as this would cause delayed polymerization).

When ready to inject, take a 23 G 5 mm needle --> flush it with glue (it has dead space of just over a ml) -
(dont expect glue to come out of the needle) -  insert the needle through the working channel of the scope - poke the varix when ready -> immediately flush with distilled water - and ask the nurse to loudly count mls squirted - by the time 2 mls is squirted, all glue has been injected, by the time third ml is being injected, pull the needle out of the varix. 

Close the needle and take it out of the scope. 

For further injection - take a new 23 G needle and repeat above steps

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